Provider Demographics
NPI:1255461638
Name:SUBURBAN PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:SUBURBAN PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOLENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-963-2920
Mailing Address - Street 1:2132 CASE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2383
Mailing Address - Country:US
Mailing Address - Phone:330-963-2920
Mailing Address - Fax:330-963-2921
Practice Address - Street 1:6950 S EDGERTON RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-3184
Practice Address - Country:US
Practice Address - Phone:440-746-1730
Practice Address - Fax:440-746-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2247812Medicaid
OH2247812Medicaid