Healthcare Provider Details

I. General information

NPI: 1033250030
Provider Name (Legal Business Name): MAYFIELD PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 BETA DR SUITE C
MAYFIELD VILLAGE OH
44143
US

IV. Provider business mailing address

781 BETA DR SUITE C
MAYFIELD VILLAGE OH
44143-2356
US

V. Phone/Fax

Practice location:
  • Phone: 440-442-7111
  • Fax: 440-460-1767
Mailing address:
  • Phone: 440-442-7111
  • Fax: 440-460-1767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number08626
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1572
License Number StateOH

VIII. Authorized Official

Name: MR. BRADLEY PAUL JENKINS
Title or Position: PRESIDENT
Credential: PT
Phone: 440-442-7111