MEDICARE: MRS. MARY RITA PACIOREK P.T.

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	225100000X	Physical Therapist	PT.006391	OH

General Provider Information

NPI Number	:	1417169814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY RITA PACIOREK P.T.

Provider Business Mailing Address
First Line	:	10902 BROOKVIEW RD
Second Line	:
City	:	BRECKSVILLE
State	:	OH
Zip	:	44141-1102
Country	:	US
Telephone Number	:	440-546-9094
Fax Number	:

Provider Business Practice Location Address
First Line	:	4630 RICHMOND RD
Second Line	:	SUITE 160
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5965
Country	:	US
Telephone Number	:	216-514-7850
Fax Number	:	216-514-7853

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

Provider Enumeration Date	:	05/06/2007
Last Update Date	:	07/08/2007

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