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NPI 1396014296

NPI 1396014296 : WELLFIT REHABILITATION AND AQUATICS LLC : WESTLAKE, OH

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General NPI Number Information
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    NPI Number           |    1396014296
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    Entity Type          |    Organization 
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    Legal Business Name  |    WELLFIT REHABILITATION AND AQUATICS LLC 
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Dates
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    Enumeration Date     |    12/21/2011
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    Last Update Date     |    12/21/2011
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Provider Practice Location Address
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    Address Line         |    671 COLUMBIA RD SUITE 2
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    City                 |    WESTLAKE
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    State                |    OH
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    Zip                  |    44145-1477
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    Country              |    US
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    Telephone            |    216-409-3979
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    671 COLUMBIA RD SUITE 2
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    City                 |    WESTLAKE
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    State                |    OH
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    Zip                  |    44145-1477
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    Country              |    US
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    Telephone            |    216-409-3979
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    Fax                  |    
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Authorized Official
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    Title or Position    |    OWNER/PROVIDER
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    Name                 |     JONATHAN  SCHAUSS 
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    Credential           |    PT
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    Telephone            |    216-409-3979
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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       |    
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    License Number State |    
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