MEDICARE: ANNETTE MARIE DEMOS 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	PT06057	OH

General Provider Information

NPI Number	:	1548477110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE MARIE DEMOS P.T.

Provider Business Mailing Address
First Line	:	2325 BELFORT AVE
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-9681
Country	:	US
Telephone Number	:	330-875-2940
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 CANTON RD NW
Second Line	:
City	:	CARROLLTON
State	:	OH
Zip	:	44615-1009
Country	:	US
Telephone Number	:	330-627-7641
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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