MEDICARE: BRIAN MERSEK PTA

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	225200000X	Physical Therapy Assistant	10202	OH

General Provider Information

NPI Number	:	1881057693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN MERSEK PTA

Provider Business Mailing Address
First Line	:	14900 PRIVATE DR
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-3470
Country	:	US
Telephone Number	:	216-851-4268
Fax Number	:	216-851-5332

Provider Business Practice Location Address
First Line	:	14900 PRIVATE DR
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-3470
Country	:	US
Telephone Number	:	216-851-4268
Fax Number	:	216-851-5332

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

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	03/30/2016

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