Provider Demographics
NPI:1851311609
Name:SYLVANIA PHYSICAL THERAPY & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:SYLVANIA PHYSICAL THERAPY & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:POOLOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:419-517-0011
Mailing Address - Street 1:4411 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:STE 202
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3525
Mailing Address - Country:US
Mailing Address - Phone:419-517-0011
Mailing Address - Fax:
Practice Address - Street 1:4411 N HOLLAND SYLVANIA RD
Practice Address - Street 2:STE 202
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3525
Practice Address - Country:US
Practice Address - Phone:419-517-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty