Provider Demographics
NPI:1134586837
Name:HLAD, PAULINE MARIE (PT)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:MARIE
Last Name:HLAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:MARIE
Other - Last Name:LIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3057 CLEVELAND AVE S
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-3625
Mailing Address - Country:US
Mailing Address - Phone:330-484-2547
Mailing Address - Fax:
Practice Address - Street 1:3057 CLEVELAND AVE S
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3625
Practice Address - Country:US
Practice Address - Phone:330-484-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist