Healthcare Provider Details

I. General information

NPI: 1922715192
Provider Name (Legal Business Name): BROOK PARK FUNCTIONAL REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5260 SMITH RD
BROOKPARK OH
44142-1747
US

IV. Provider business mailing address

PO BOX 64
RICHFIELD OH
44286-0064
US

V. Phone/Fax

Practice location:
  • Phone: 216-284-3077
  • Fax: 216-586-6780
Mailing address:
  • Phone: 216-343-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXIS FRANTZIS
Title or Position: OWNER
Credential: DC
Phone: 216-343-9878