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General NPI Number Information
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NPI Number | 1538126693
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Entity Type | Organization
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Legal Business Name | WESTERN RESERVE PROFESSIONAL GROUP INC
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 174 CURRIE HALL PKWY STE D
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City | KENT
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State | OH
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Zip | 44240-4387
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Country | US
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Telephone | 330-548-0086
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Fax | 330-548-0085
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Provider Business Mailing Address
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Address Line | PO BOX 951971
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City | CLEVELAND
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State | OH
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Zip | 44193-0021
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Country | US
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Telephone | 330-548-0080
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Fax | 330-548-0085
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | KELLY ANN SEMANCIK
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Credential |
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Telephone | 330-548-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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