MEDICARE: PAMELA J HIETANEN LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA.09434	OH
2	225700000X	Massage Therapist	33.013261	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1154711893	OTHER	OH	SELF-PAY

General Provider Information

NPI Number	:	1154711893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA J HIETANEN LPTA

Provider Business Mailing Address
First Line	:	25001 EMERY RD STE 100
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5627
Country	:	US
Telephone Number	:	216-285-4070
Fax Number	:	216-201-5230

Provider Business Practice Location Address
First Line	:	25001 EMERY RD
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5626
Country	:	US
Telephone Number	:	216-285-4070
Fax Number	:	216-201-5230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	03/17/2018

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Directions to “ PAMELA J HIETANEN LPTA” Practice Location

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