Healthcare Provider Details

I. General information

NPI: 1437384120
Provider Name (Legal Business Name): HEADWAY PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2009
Last Update Date: 05/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9165 FAIRMOUNT RD
NOVELTY OH
44072-9765
US

IV. Provider business mailing address

9165 FAIRMOUNT RD
NOVELTY OH
44072-9765
US

V. Phone/Fax

Practice location:
  • Phone: 440-223-9765
  • Fax:
Mailing address:
  • Phone: 440-223-9765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number009726
License Number StateOH

VIII. Authorized Official

Name: MR. ERAN SHILOH
Title or Position: OWNER/PRESIDENT
Credential: PT
Phone: 440-223-9765