MEDICARE: PR2 PHYSICAL THERAPY AND MYOFASCIAL CENTER, 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	3881	OH

General Provider Information

NPI Number	:	1619002169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PR2 PHYSICAL THERAPY AND MYOFASCIAL CENTER, INC.

Provider Business Mailing Address
First Line	:	5822 MIDDLEBRANCH AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-3661
Country	:	US
Telephone Number	:	330-492-1193
Fax Number	:	330-492-1193

Provider Business Practice Location Address
First Line	:	5822 MIDDLEBRANCH AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-3661
Country	:	US
Telephone Number	:	330-492-1193
Fax Number	:	330-492-1193

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PATRICIA LOUISE HAMILTON
Credential	:	PT
Telephone Number	:	330-492-1193

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/22/2020

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