Healthcare Provider Details

I. General information

NPI: 1740337443
Provider Name (Legal Business Name): GREG DAVID HUFFMAN PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 WINDSOR DR
CORTLAND OH
44410-2703
US

IV. Provider business mailing address

230 WINDSOR DR
CORTLAND OH
44410-2703
US

V. Phone/Fax

Practice location:
  • Phone: 330-637-6000
  • Fax: 330-637-6002
Mailing address:
  • Phone: 330-984-2834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT . 11591
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: