=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922808625
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMT CLINICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3690 ORANGE PL STE 250
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-4438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-560-4530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9487 RIVER BIRCH RUN
-----------------------------------------------------
City | BRECKSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44141-3541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GEORGE FRIEDHOFF
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 614-560-4530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------