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NPI Code Detail

MEDICARE: DIANNE RODAK PT

MEDICARE: DIANNE RODAK PT
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
1225100000XPhysical TherapistPT3115OH

General Provider Information

NPI Number : 1003866310
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNE RODAK PT
Provider Business Mailing Address
First Line : 23825 COMMERCE PARK
Second Line : STE B
City : BEACHWOOD
State : OH
Zip : 44122-5837
Country : US
Telephone Number : 216-292-6363
Fax Number : 216-292-6306
Provider Business Practice Location Address
First Line : 731 BETA DR
Second Line :
City : MAYFIELD VILLAGE
State : OH
Zip : 44143-2366
Country : US
Telephone Number : 440-461-2006
Fax Number : 440-461-2009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 07/08/2007

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