MEDICARE: CREEKSIDE THERAPY CLINIC, LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1306131149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREEKSIDE THERAPY CLINIC, LLC

Provider Business Mailing Address
First Line	:	20611 EUCLID AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44117-1521
Country	:	US
Telephone Number	:	440-658-1040
Fax Number	:	866-629-9730

Provider Business Practice Location Address
First Line	:	20611 EUCLID AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44117-1521
Country	:	US
Telephone Number	:	440-658-1040
Fax Number	:	866-629-9730

Authorized Official
Title or Position	:	MANAGING MEMEBER
Name	:	MR. ELI M GUNZBURG
Credential	:
Telephone Number	:	440-658-1040

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	06/09/2011

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