Healthcare Provider Details

I. General information

NPI: 1003494725
Provider Name (Legal Business Name): ELISE BIXENSTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6960 S EDGERTON RD
BRECKSVILLE OH
44141-3184
US

IV. Provider business mailing address

5900 FATHER CARUSO DR APT 4103
CLEVELAND OH
44102-1003
US

V. Phone/Fax

Practice location:
  • Phone: 440-241-8366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019070
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: