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General NPI Number Information
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NPI Number | 1336566108
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Entity Type | Individual
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Provider Name | MARIA MEPHAM PT
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Gender | Female
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Dates
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Enumeration Date | 03/18/2014
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 14519 DETROIT AVE FIRST FLOOR - REHAB SERVICES
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City | LAKEWOOD
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State | OH
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Zip | 44107-4316
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Country | US
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Telephone | 216-227-2474
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Fax | 216-529-7262
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Provider Business Mailing Address
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Address Line | 14519 DETROIT AVE FIRST FLOOR - REHAB SERVICES
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City | LAKEWOOD
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State | OH
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Zip | 44107-4316
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number | 006256
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License Number State | OH
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