Healthcare Provider Details

I. General information

NPI: 1184462764
Provider Name (Legal Business Name): TLC PHYSICAL THERAPY ASSOCIATION CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26250 EUCLID AVE
EUCLID OH
44132-3305
US

IV. Provider business mailing address

4066 STILMORE RD
SOUTH EUCLID OH
44121-2615
US

V. Phone/Fax

Practice location:
  • Phone: 216-355-4639
  • Fax:
Mailing address:
  • Phone: 216-355-4639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SERITA CLAY
Title or Position: OWNER
Credential:
Phone: 216-355-4639