MEDICARE: SUSAN ANN STOFFKO 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	03126	OH

General Provider Information

NPI Number	:	1770605248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ANN STOFFKO P.T.

Provider Business Mailing Address
First Line	:	7000 TOWN CENTRE DR
Second Line	:	SUITE 400
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-4008
Country	:	US
Telephone Number	:	440-526-8566
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 TOWN CENTRE DR
Second Line	:	SUITE 400
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-4008
Country	:	US
Telephone Number	:	440-526-8566
Fax Number	:

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	05/28/2009

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