Provider Demographics
NPI:1255371464
Name:NEWMAN, SALLY A (PT)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-4008
Mailing Address - Country:US
Mailing Address - Phone:440-230-1133
Mailing Address - Fax:440-230-9243
Practice Address - Street 1:5340 ROYALTON RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4008
Practice Address - Country:US
Practice Address - Phone:440-230-1133
Practice Address - Fax:440-230-9243
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT005083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2161084Medicaid
OHNE00789591Medicare PIN
OH2161084Medicaid