Healthcare Provider Details

I. General information

NPI: 1104142280
Provider Name (Legal Business Name): MARY KONSTAS NAKHEL MS, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 EAST 79TH ST. EAST PROFESSIONAL CENTER. ROOM 107
CLEVELAND OH
44103
US

IV. Provider business mailing address

4010 WHITMAN AVE
CLEVELAND OH
44113-3231
US

V. Phone/Fax

Practice location:
  • Phone: 216-795-8092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT. 011137
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: