Provider Demographics
NPI:1790992451
Name:STO-KENT PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:STO-KENT PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-673-2600
Mailing Address - Street 1:500 S DEPEYSTER ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3697
Mailing Address - Country:US
Mailing Address - Phone:330-673-2600
Mailing Address - Fax:330-673-3200
Practice Address - Street 1:500 S DEPEYSTER ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3697
Practice Address - Country:US
Practice Address - Phone:330-673-2600
Practice Address - Fax:330-673-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2910174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0992716Medicaid
1265423412OtherNPI FOR CLAUDIA MILLER
OH0992716Medicaid