=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407121130
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRONGSVILLE PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2012
-----------------------------------------------------
Last Update Date | 09/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13477 PROSPECT RD # 104D
-----------------------------------------------------
City | STRONGSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44149-3867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-783-8720
-----------------------------------------------------
Fax | 440-783-8721
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13477 PROSPECT RD # 104D
-----------------------------------------------------
City | STRONGSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44149-3867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-783-8720
-----------------------------------------------------
Fax | 440-783-8721
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | JOSEPH M KNAZEK JR.
-----------------------------------------------------
Credential | MPT
-----------------------------------------------------
Telephone | 440-783-8720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT 011738
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------