Healthcare Provider Details

I. General information

NPI: 1578567335
Provider Name (Legal Business Name): WESTERN RESERVE THERAPISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 PHILOMETHIAN ST REAR
CHAGRIN FALLS OH
44022-2926
US

IV. Provider business mailing address

54 PHILOMETHIAN ST REAR REAR
CHAGRIN FALLS OH
44022-2926
US

V. Phone/Fax

Practice location:
  • Phone: 440-247-2476
  • Fax: 440-247-5278
Mailing address:
  • Phone: 440-247-2476
  • Fax: 440-247-5278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT01368
License Number StateOH

VIII. Authorized Official

Name: MR. JAMES T. MAIER
Title or Position: PRESIDENT
Credential: P.T., M.S.
Phone: 440-247-2476