MEDICARE: WILLOUGHBY THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1003131368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOUGHBY THERAPY INC

Provider Business Mailing Address
First Line	:	30841 EUCLID AVE
Second Line	:	SUITE 202
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-3100
Country	:	US
Telephone Number	:	440-944-5050
Fax Number	:	440-944-5250

Provider Business Practice Location Address
First Line	:	30841 EUCLID AVE
Second Line	:	SUITE 202
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-3100
Country	:	US
Telephone Number	:	440-944-5050
Fax Number	:	440-944-5250

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUZANNE BENI
Credential	:
Telephone Number	:	440-944-5050

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	08/02/2012

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