Healthcare Provider Details

I. General information

NPI: 1215023072
Provider Name (Legal Business Name): MARC ANTHONY VASIL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5813 MAYFIELD RD SUITE 202
MAYFIELD HEIGHTS OH
44124-2932
US

IV. Provider business mailing address

PO BOX 361098
STRONGSVILLE OH
44136-0019
US

V. Phone/Fax

Practice location:
  • Phone: 440-229-5822
  • Fax: 440-448-4902
Mailing address:
  • Phone: 440-229-5822
  • Fax: 440-448-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT09270
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT09270
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: