Provider Demographics
NPI:1710244710
Name:CORE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CORE PHYSICAL THERAPY
Other - Org Name:WELLNESS DEFINED OF MAYFIELD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VASIL
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:440-229-5822
Mailing Address - Street 1:5813 MAYFIELD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2937
Mailing Address - Country:US
Mailing Address - Phone:440-683-4438
Mailing Address - Fax:440-683-4371
Practice Address - Street 1:5813 MAYFIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2937
Practice Address - Country:US
Practice Address - Phone:440-683-4438
Practice Address - Fax:440-683-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy