Healthcare Provider Details

I. General information

NPI: 1194777433
Provider Name (Legal Business Name): EDWIN G RISING PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 ST RT 60 STE 3
VERMILION OH
44089
US

IV. Provider business mailing address

1605 ST RT 60 STE 3
VERMILION OH
44089
US

V. Phone/Fax

Practice location:
  • Phone: 440-967-2508
  • Fax: 440-967-4023
Mailing address:
  • Phone: 440-967-2508
  • Fax: 440-967-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009724
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: