MEDICARE: WESTERN RESERVE THERAPISTS, 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	261QP2000X	Physical Therapy Clinic/Center	PT01368	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578567335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN RESERVE THERAPISTS, INC.

Provider Business Mailing Address
First Line	:	54 PHILOMETHIAN ST REAR
Second Line	:	REAR
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-2926
Country	:	US
Telephone Number	:	440-247-2476
Fax Number	:	440-247-5278

Provider Business Practice Location Address
First Line	:	54 PHILOMETHIAN ST
Second Line	:	REAR
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-2926
Country	:	US
Telephone Number	:	440-247-2476
Fax Number	:	440-247-5278

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAMES T. MAIER
Credential	:	P.T., M.S.
Telephone Number	:	440-247-2476

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	12/11/2008

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