Provider Demographics
NPI:1841873221
Name:NETTGEN, WILLIAM EUGENE
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EUGENE
Last Name:NETTGEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7416 LANIER DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6621
Mailing Address - Country:US
Mailing Address - Phone:440-530-0473
Mailing Address - Fax:
Practice Address - Street 1:9055 W SPRAGUE RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1285
Practice Address - Country:US
Practice Address - Phone:440-345-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty