Healthcare Provider Details

I. General information

NPI: 1093872376
Provider Name (Legal Business Name): SYLVANIA ORTHOPAEDICS AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 ALEXIS RD
SYLVANIA OH
43560-2349
US

IV. Provider business mailing address

5750 ALEXIS RD
SYLVANIA OH
43560-2349
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-0300
  • Fax: 419-824-0500
Mailing address:
  • Phone: 419-824-0300
  • Fax: 419-824-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36002275
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateOH

VIII. Authorized Official

Name: JOSEPH J. RUSIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-824-0300