Provider Demographics
NPI:1598109530
Name:CLEVELAND CLINIC
Entity Type:Organization
Organization Name:CLEVELAND CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALABRESE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:216-408-7562
Mailing Address - Street 1:7533 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6001
Mailing Address - Country:US
Mailing Address - Phone:440-205-1714
Mailing Address - Fax:440-205-1792
Practice Address - Street 1:7533 CENTER ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6001
Practice Address - Country:US
Practice Address - Phone:440-205-1714
Practice Address - Fax:440-205-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT007240261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy