Provider Demographics
NPI:1821583360
Name:ANSPACH, RAVEN (DPT)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:ANSPACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RAVEN
Other - Middle Name:
Other - Last Name:CILANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4700 RICHMOND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5985
Mailing Address - Country:US
Mailing Address - Phone:216-378-9390
Mailing Address - Fax:216-378-1735
Practice Address - Street 1:4700 RICHMOND RD STE 100
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5985
Practice Address - Country:US
Practice Address - Phone:216-378-9390
Practice Address - Fax:216-378-1735
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty