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NPI Code Detail

MEDICARE: RAVELLE LYNNE NEWMARK PTA

MEDICARE: RAVELLE LYNNE NEWMARK PTA
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
1225200000XPhysical Therapy Assistant686OH

General Provider Information

NPI Number : 1184744278
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVELLE LYNNE NEWMARK PTA
Provider Business Mailing Address
First Line : 4028 ARDMORE RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44121-2522
Country : US
Telephone Number : 216-382-3839
Fax Number :
Provider Business Practice Location Address
First Line : 6606 CARNEGIE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44103-4622
Country : US
Telephone Number : 216-361-1414
Fax Number : 216-426-1383
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2007
Last Update Date : 07/08/2007

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