Healthcare Provider Details

I. General information

NPI: 1821400698
Provider Name (Legal Business Name): DANIELLE CICHON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 MCCRACKEN RD # MA1-150
GARFIELD HTS OH
44125-2914
US

IV. Provider business mailing address

18901 LAKE SHORE BLVD EUCLID HOSPITAL HEALTH CENTER, #200
EUCLID OH
44119-1078
US

V. Phone/Fax

Practice location:
  • Phone: 216-587-8108
  • Fax:
Mailing address:
  • Phone: 216-692-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number013381
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: