Healthcare Provider Details

I. General information

NPI: 1134542236
Provider Name (Legal Business Name): MOGYORDY THERAPY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26927 DETROIT RD
WESTLAKE OH
44145-2370
US

IV. Provider business mailing address

26927 DETROIT RD
WESTLAKE OH
44145-2370
US

V. Phone/Fax

Practice location:
  • Phone: 440-892-5367
  • Fax: 440-249-5094
Mailing address:
  • Phone: 440-892-5367
  • Fax: 440-249-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number6259
License Number StateOH

VIII. Authorized Official

Name: MRS. JENNIFER KOVATS
Title or Position: MANAGER
Credential:
Phone: 440-892-5367