Healthcare Provider Details

I. General information

NPI: 1790820355
Provider Name (Legal Business Name): PORTAGE PHYSICAL THERAPISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 N CLEVELAND AVE STE C
MOGADORE OH
44260-1365
US

IV. Provider business mailing address

771 N FREEDOM ST
RAVENNA OH
44266-2470
US

V. Phone/Fax

Practice location:
  • Phone: 330-628-0736
  • Fax: 330-628-0739
Mailing address:
  • Phone: 330-297-9020
  • Fax: 330-297-9094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. DARBIE FERRARA-MATHYS
Title or Position: C.E.O.
Credential:
Phone: 330-297-9020