Provider Demographics
NPI:1740292994
Name:NOLAN, MARIA M (PT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:M
Last Name:NOLAN
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 1:7000 TOWN CENTRE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4008
Mailing Address - Country:US
Mailing Address - Phone:440-526-8566
Mailing Address - Fax:440-546-8280
Practice Address - Street 1:7000 TOWN CENTRE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-4008
Practice Address - Country:US
Practice Address - Phone:440-526-8566
Practice Address - Fax:440-546-8280
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0638279Medicaid
OH137883OtherANTHEM
OH0638279Medicaid