Healthcare Provider Details

I. General information

NPI: 1952960676
Provider Name (Legal Business Name): PEARL PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 WEST BLVD STE 3
BOARDMAN OH
44512-4346
US

IV. Provider business mailing address

7250 WEST BLVD STE 3
BOARDMAN OH
44512-4346
US

V. Phone/Fax

Practice location:
  • Phone: 330-992-8080
  • Fax: 330-992-8081
Mailing address:
  • Phone: 330-992-8080
  • Fax: 330-992-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH ELIZABETH TAYLOR
Title or Position: OWNER
Credential:
Phone: 330-727-1952