Healthcare Provider Details

I. General information

NPI: 1386456564
Provider Name (Legal Business Name): JEREMIAH URBAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7266 COMMERCE DR
MENTOR OH
44060-5308
US

IV. Provider business mailing address

1078 RIVERSIDE DR
PAINESVILLE OH
44077-5266
US

V. Phone/Fax

Practice location:
  • Phone: 216-678-4900
  • Fax:
Mailing address:
  • Phone: 216-272-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.022687
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: