Healthcare Provider Details

I. General information

NPI: 1518396969
Provider Name (Legal Business Name): WILLIAM BEDFORD II DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BEREA COMMONS STE 10
BEREA OH
44017-2535
US

IV. Provider business mailing address

2 BEREA COMMONS STE 10
BEREA OH
44017-2535
US

V. Phone/Fax

Practice location:
  • Phone: 440-973-4950
  • Fax: 440-973-4951
Mailing address:
  • Phone: 440-973-4950
  • Fax: 440-973-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.014365
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: