Healthcare Provider Details

I. General information

NPI: 1417164781
Provider Name (Legal Business Name): N DALE KAMINSKI P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11820 NOTTINGHAM PKWY
N ROYALTON OH
44133-6067
US

IV. Provider business mailing address

11820 NOTTINGHAM PKWY
N ROYALTON OH
44133-6067
US

V. Phone/Fax

Practice location:
  • Phone: 440-582-1459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 004637
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: