Healthcare Provider Details

I. General information

NPI: 1396937033
Provider Name (Legal Business Name): NORTHEAST OHIO THERAPY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 03/24/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 MARKET AVE N
CANTON OH
44721-3127
US

IV. Provider business mailing address

6310 MARKET AVE N
CANTON OH
44721-3127
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-6655
  • Fax: 330-494-8195
Mailing address:
  • Phone: 330-494-6655
  • Fax: 330-494-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT-5585
License Number StateOH

VIII. Authorized Official

Name: MR. GREGORY SCOTT JAMES
Title or Position: PRESIDENT
Credential: PT
Phone: 330-494-6655