Provider Demographics
NPI:1639203060
Name:STRAIGHT AHEAD PEDIATRIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:STRAIGHT AHEAD PEDIATRIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARMEL-ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:440-460-0923
Mailing Address - Street 1:781 BETA DR STE C
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2360
Mailing Address - Country:US
Mailing Address - Phone:440-460-0923
Mailing Address - Fax:440-460-1767
Practice Address - Street 1:781 BETA DR STE C
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44143-2360
Practice Address - Country:US
Practice Address - Phone:440-460-0923
Practice Address - Fax:440-460-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT03851225100000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000503076Medicare UPIN