Provider Demographics
NPI:1972856524
Name:THE PT CENTER FOR SPORTS MEDICINE
Entity Type:Organization
Organization Name:THE PT CENTER FOR SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OUTWATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-869-2635
Mailing Address - Street 1:2660 W MARKET ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4209
Mailing Address - Country:US
Mailing Address - Phone:330-869-2635
Mailing Address - Fax:330-869-8315
Practice Address - Street 1:2660 W MARKET ST STE 300
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4209
Practice Address - Country:US
Practice Address - Phone:330-869-2635
Practice Address - Fax:330-869-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0037402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty