MEDICARE: MR. ROBERT SOMRAK III PTA

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	225200000X	Physical Therapy Assistant	PTA012587	OH

General Provider Information

NPI Number	:	1023973948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT SOMRAK III PTA

Provider Business Mailing Address
First Line	:	11844 E HILL DR
Second Line	:
City	:	CHESTERLAND
State	:	OH
Zip	:	44026-1753
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVE
Second Line	:	BOLWELL SUITE 4100
City	:	CLEVELAND
State	:	OH
Zip	:	44106
Country	:	US
Telephone Number	:	216-844-7868
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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