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NPI Code Detail

MEDICARE: RAVEN ANSPACH DPT

MEDICARE: RAVEN ANSPACH DPT
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
1225100000XPhysical TherapistPT017359OH

General Provider Information

NPI Number : 1821583360
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN ANSPACH DPT
Provider Business Mailing Address
First Line : 4700 RICHMOND RD STE 100
Second Line :
City : WARRENSVILLE HEIGHTS
State : OH
Zip : 44128-5985
Country : US
Telephone Number : 216-378-9390
Fax Number : 216-378-1735
Provider Business Practice Location Address
First Line : 4700 RICHMOND RD STE 100
Second Line :
City : WARRENSVILLE HEIGHTS
State : OH
Zip : 44128-5985
Country : US
Telephone Number : 216-378-9390
Fax Number : 216-378-1735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2018
Last Update Date : 06/13/2019

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