MEDICARE: MRS. WILLIE PEARL FREEMAN

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	0165	OH

General Provider Information

NPI Number	:	1992193841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WILLIE PEARL FREEMAN

Provider Business Mailing Address
First Line	:	23886 DAVID DR
Second Line	:
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-1639
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19900 CLARE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44137-1806
Country	:	US
Telephone Number	:	216-662-3343
Fax Number	:

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

Provider Enumeration Date	:	12/30/2014
Last Update Date	:	12/30/2014

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