Healthcare Provider Details

I. General information

NPI: 1528775913
Provider Name (Legal Business Name): VITALITY PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 FULTON DR NW
CANTON OH
44718-2819
US

IV. Provider business mailing address

7164 FIELDMONT ST NW
NORTH CANTON OH
44720-8828
US

V. Phone/Fax

Practice location:
  • Phone: 330-203-1078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAYLA KEREK
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: PT
Phone: 330-808-2481