Provider Demographics
NPI:1649627050
Name:PHYSIO ORTHOPEDICS AND PERFORMANCE LLC
Entity type:Organization
Organization Name:PHYSIO ORTHOPEDICS AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:PAVLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:330-289-9269
Mailing Address - Street 1:69 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1328
Mailing Address - Country:US
Mailing Address - Phone:330-289-2969
Mailing Address - Fax:
Practice Address - Street 1:69 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1328
Practice Address - Country:US
Practice Address - Phone:330-289-2969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016295261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy