Healthcare Provider Details

I. General information

NPI: 1467115030
Provider Name (Legal Business Name): PT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 W MARKET ST STE 300
FAIRLAWN OH
44333-4209
US

IV. Provider business mailing address

2660 W MARKET ST STE 300
FAIRLAWN OH
44333-4209
US

V. Phone/Fax

Practice location:
  • Phone: 330-869-2635
  • Fax: 330-869-8315
Mailing address:
  • Phone: 330-869-2635
  • Fax: 330-869-8315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN OUTWATER SR.
Title or Position: OWNER/ PHYSICAL THERAPIST
Credential: PT, ATC
Phone: 330-869-2635