Healthcare Provider Details

I. General information

NPI: 1902910813
Provider Name (Legal Business Name): ANGELA L HEJDUK R.K.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 E 9TH ST
CLEVELAND OH
44115-1313
US

IV. Provider business mailing address

33332 VINE ST 201-H
WILLOWICK OH
44095-3418
US

V. Phone/Fax

Practice location:
  • Phone: 216-687-7674
  • Fax:
Mailing address:
  • Phone: 216-272-7896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1702
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: