Healthcare Provider Details

I. General information

NPI: 1669669917
Provider Name (Legal Business Name): CRYSTAL CLINIC ORTHOPAEDIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3557 EMBASSY PKWY
AKRON OH
44333-8358
US

IV. Provider business mailing address

PO BOX 72434
CLEVELAND OH
44192-0002
US

V. Phone/Fax

Practice location:
  • Phone: 330-670-1005
  • Fax: 330-670-1007
Mailing address:
  • Phone: 330-670-1005
  • Fax: 330-670-4109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License NumberNOT APPLICABLE
License Number State

VIII. Authorized Official

Name: DANIEL J FERRY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 330-670-4152