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General NPI Number Information
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NPI Number | 1528775913
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Entity Type | Organization
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Legal Business Name | VITALITY PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 4105 FULTON DR NW
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City | CANTON
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State | OH
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Zip | 44718-2819
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Country | US
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Telephone | 330-203-1078
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Fax |
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Provider Business Mailing Address
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Address Line | 7164 FIELDMONT ST NW
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City | NORTH CANTON
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State | OH
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Zip | 44720-8828
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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 | DOCTOR OF PHYSICAL THERAPY
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Name | KAYLA KEREK
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Credential | PT
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Telephone | 330-808-2481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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