=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689302358
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIMITLESS REHABILITATION AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2022
-----------------------------------------------------
Last Update Date | 09/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 456 LOWELL DR
-----------------------------------------------------
City | HIGHLAND HTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44143-3618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-702-6806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 456 LOWELL DR
-----------------------------------------------------
City | HIGHLAND HTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44143-3618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MATTHEW D BURNETT
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 216-702-6806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------