Provider Demographics
NPI:1598821985
Name:WEST, LORETTA MICHELLE (PT)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:MICHELLE
Last Name:WEST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22450
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-0450
Mailing Address - Country:US
Mailing Address - Phone:216-233-4298
Mailing Address - Fax:216-593-7070
Practice Address - Street 1:3355 RICHMOND RD
Practice Address - Street 2:SUITE 101-A
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4100
Practice Address - Country:US
Practice Address - Phone:216-593-7070
Practice Address - Fax:216-593-7074
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 9924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2452699Medicaid
OH2452699Medicaid