Healthcare Provider Details

I. General information

NPI: 1780307488
Provider Name (Legal Business Name): ENSTA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25955 DETROIT RD STE 16
WESTLAKE OH
44145-2426
US

IV. Provider business mailing address

3681 RANFIELD RD
KENT OH
44240-6783
US

V. Phone/Fax

Practice location:
  • Phone: 330-807-2431
  • Fax:
Mailing address:
  • Phone: 330-807-2431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIC STACKS
Title or Position: PRESIDENT
Credential:
Phone: 330-807-2431