MEDICARE: MS. ELIZABETH GREENSLADE HOCKEY PT

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	2251P0200X	Pediatric Physical Therapist	3285	OH

General Provider Information

NPI Number	:	1376768945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH GREENSLADE HOCKEY PT

Provider Business Mailing Address
First Line	:	1620 WOOD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1744
Country	:	US
Telephone Number	:	216-382-7347
Fax Number	:	216-382-7347

Provider Business Practice Location Address
First Line	:	1620 WOOD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1744
Country	:	US
Telephone Number	:	216-382-7347
Fax Number	:	216-382-7347

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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