Provider Demographics
NPI:1639389604
Name:VALENTINO, MARY ELLEN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:VALENTINO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 27TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-1703
Mailing Address - Country:US
Mailing Address - Phone:330-456-9941
Mailing Address - Fax:
Practice Address - Street 1:701 27TH ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-1703
Practice Address - Country:US
Practice Address - Phone:330-705-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT5140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist