Provider Demographics
NPI:1396937033
Name:NORTHEAST OHIO THERAPY ASSOCIATES, LLC
Entity type:Organization
Organization Name:NORTHEAST OHIO THERAPY ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-494-6655
Mailing Address - Street 1:6310 MARKET AVE N
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-3127
Mailing Address - Country:US
Mailing Address - Phone:330-494-6655
Mailing Address - Fax:330-494-8195
Practice Address - Street 1:6310 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-3127
Practice Address - Country:US
Practice Address - Phone:330-494-6655
Practice Address - Fax:330-494-8195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-5585261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2505579Medicaid
OH9355671Medicare PIN