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General NPI Number Information
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NPI Number | 1992525026
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Entity Type | Organization
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Legal Business Name | FERTILITY PT, LLC
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 2841 RIVIERA DR
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City | FAIRLAWN
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State | OH
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Zip | 44333-3413
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Country | US
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Telephone | 440-665-7482
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Fax |
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Provider Business Mailing Address
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Address Line | 7401 STATE ROUTE 43
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City | KENT
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State | OH
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Zip | 44240-5964
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Country | US
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Telephone | 440-665-7482
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOANNA PAVLAK
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Credential | DPT
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Telephone | 440-665-7482
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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 |
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License Number State |
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