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General NPI Number Information
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NPI Number | 1740616820
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Entity Type | Organization
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Legal Business Name | CLEVELAND CLINIC SPORTS HEALTH CENTER
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 4683 WAYNE ROAD
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City | MANTUA
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State | OH
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Zip | 44255
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Country | US
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Telephone | 330-274-8396
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Fax |
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Provider Business Mailing Address
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Address Line | 4683 WAYNE RD
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City | MANTUA
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State | OH
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Zip | 44255-9664
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Country | US
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Telephone | 330-274-8396
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Fax |
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Authorized Official
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Title or Position | COORDINATOR OF AT
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Name | GARY MILLER
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Credential |
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Telephone | 216-518-3429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | AT. 004124
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License Number State | OH
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