Healthcare Provider Details

I. General information

NPI: 1174796593
Provider Name (Legal Business Name): ELIZABETH WOJCIK P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MENTOR AVE SUITE 210
MENTOR OH
44060-8713
US

IV. Provider business mailing address

5340 ROYALTON RD P O BOX 33396
NORTH ROYALTON OH
44133-4008
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-0934
  • Fax: 440-352-7562
Mailing address:
  • Phone: 440-230-1133
  • Fax: 440-230-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT11515
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: