=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215726898
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISON POPHAL PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2025
-----------------------------------------------------
Last Update Date | 05/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8300 NORTON PKWY
-----------------------------------------------------
City | MENTOR
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44060-6601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-578-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2482 SAYBROOK RD
-----------------------------------------------------
City | UNIVERSITY HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118-4441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-509-8870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT019004
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------