MEDICARE: JAMES SCHROCK 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
1	225100000X	Physical Therapist	PT09110	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000560735	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1780635185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES SCHROCK PT

Provider Business Mailing Address
First Line	:	24400 HIGHPOINT RD
Second Line	:	STE 10
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-6054
Country	:	US
Telephone Number	:	216-896-0824
Fax Number	:	216-896-0825

Provider Business Practice Location 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

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	06/25/2008

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