Provider Demographics
NPI:1578567335
Name:WESTERN RESERVE THERAPISTS, INC.
Entity Type:Organization
Organization Name:WESTERN RESERVE THERAPISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:440-247-2476
Mailing Address - Street 1:54 PHILOMETHIAN ST REAR
Mailing Address - Street 2:REAR
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-2926
Mailing Address - Country:US
Mailing Address - Phone:440-247-2476
Mailing Address - Fax:440-247-5278
Practice Address - Street 1:54 PHILOMETHIAN ST
Practice Address - Street 2:REAR
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-2926
Practice Address - Country:US
Practice Address - Phone:440-247-2476
Practice Address - Fax:440-247-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT01368261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217705Medicaid
OH0217705Medicaid