Doctor Name: | EDWARD ANTHONY JENDRISAK |
NPI Number: | 1114931292 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | PT05915 |
Business Practice Address: | 4054 Forestridge Dr Richfield, OH - 442869576 |
Business Phone Number: | 3306590769 |
Business Fax Number: | |
Mailing Address: | 4054 Forestridge Dr, RICHFIELD |
State: | OH |
Postal Code: | 442869576 |
Phone Number: | 3306590769 |
Fax Number: | |
NPI Enumeration Date: | 07/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251G0304X |
License Number: | PT05915 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Geriatrics |
Taxonomy Definition: |