| Organization Name: | CLEVELAND CLINIC SPORTS HEALTH CENTER |
| NPI Number: | 1740616820 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY MILLER (COORDINATOR OF AT) |
| Mailing Address: | 4683 Wayne Road Mantua |
| State: | OH US |
| Postal Code: | 44255 |
| Phone Number: | 3302748396 |
| Fax Number: | |
| NPI Enumeration Date: | 09/19/2013 |
| NPI Last Update Date: | 09/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | AT. 004124 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |