Provider Demographics
NPI:1992360846
Name:RAINSBERGER, ELLISON R (MT, COLONICS)
Entity Type:Individual
Prefix:MS
First Name:ELLISON
Middle Name:R
Last Name:RAINSBERGER
Suffix:
Gender:F
Credentials:MT, COLONICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WINSTON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6221
Mailing Address - Country:US
Mailing Address - Phone:330-819-4425
Mailing Address - Fax:
Practice Address - Street 1:16363 PEARL RD STE C
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6002
Practice Address - Country:US
Practice Address - Phone:440-238-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-006907225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist