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General NPI Number Information
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NPI Number | 1760910418
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Entity Type | Organization
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Legal Business Name | PHYSICAL ADVANTAGE OF OHIO, LLC
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 05/25/2017
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Provider Practice Location Address
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Address Line | 727 E TURKEYFOOT LAKE RD STE M
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City | AKRON
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State | OH
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Zip | 44319-4111
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Country | US
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Telephone | 330-280-3677
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Fax |
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Provider Business Mailing Address
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Address Line | 8321 WINTERWOOD AVE NW
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City | NORTH CANTON
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State | OH
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Zip | 44720-5162
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Country | US
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Telephone | 330-280-3677
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MELISSA ANN RIFE
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Credential | PT
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Telephone | 330-280-3677
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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 | 004536
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License Number State | OH
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