Provider Demographics
NPI:1689691776
Name:AGM PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:AGM PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:440-357-6677
Mailing Address - Street 1:6000 HEISLEY RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-1836
Mailing Address - Country:US
Mailing Address - Phone:440-357-6677
Mailing Address - Fax:440-357-6681
Practice Address - Street 1:6000 HEISLEY RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-1836
Practice Address - Country:US
Practice Address - Phone:440-357-6677
Practice Address - Fax:440-357-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9343612Medicare PIN