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General NPI Number Information
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NPI Number | 1427658426
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Entity Type | Individual
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Provider Name | CALLAWAY BENJAMIN SLUSARZ DPT
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Gender | Male
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 8881 SCHAEFFER ST
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City | MENTOR
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State | OH
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Zip | 44060-5035
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Country | US
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Telephone | 440-255-9309
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Fax |
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Provider Business Mailing Address
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Address Line | 11906 MEADOWRIDGE DR
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City | CHESTERLAND
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State | OH
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Zip | 44026-1834
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Country | US
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Telephone | 440-539-7393
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT018567
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License Number State | OH
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