Healthcare Provider Details

I. General information

NPI: 1023588902
Provider Name (Legal Business Name): BLUE SKY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W MAIN ST STE B
CANFIELD OH
44406-1454
US

IV. Provider business mailing address

510 W MAIN ST STE B
CANFIELD OH
44406-1454
US

V. Phone/Fax

Practice location:
  • Phone: 330-301-4762
  • Fax: 312-488-4131
Mailing address:
  • Phone: 330-301-4762
  • Fax: 312-488-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: RENEE M HALFHILL
Title or Position: OWNER
Credential:
Phone: 330-301-4762