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General NPI Number Information
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NPI Number | 1104904663
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Entity Type | Organization
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Legal Business Name | INTERDISCIPLINARY MEDICAL MGT
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2103 NILES CORTLAND RD
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City | WARREN
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State | OH
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Zip | 44484
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Country | US
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Telephone | 330-544-3737
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Fax | 330-544-3904
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Provider Business Mailing Address
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Address Line | 2103 NILES CORTLAND RD
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City | WARREN
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State | OH
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Zip | 44484
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Country | US
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Telephone | 330-544-3737
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Fax | 330-544-3904
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Authorized Official
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Title or Position | PRESIDENT
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Name | CATHERINE A STYCHNO
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Credential | OWNER
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Telephone | 330-544-3737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6881
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 6881
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License Number State | OH
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