Healthcare Provider Details

I. General information

NPI: 1649594755
Provider Name (Legal Business Name): JANE FRUSCELLA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 E MAPLE ST
NORTH CANTON OH
44720
US

IV. Provider business mailing address

1940 THORNHILL DR
AKRON OH
44313-5461
US

V. Phone/Fax

Practice location:
  • Phone: 330-498-8200
  • Fax:
Mailing address:
  • Phone: 330-864-8776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 5571
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: