Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | .011135 | OH |
Y | 2251P0200X | Physical Therapist - Pediatrics | .011135 | OH |
NPI | 1124435557 |
---|---|
Provider Name | Kathleen Merdes |
First Address | Cleveland, OH 44195 |
Second Address | Cleveland, OH 44195 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2014 |
Last Update Date | 17/07/2014 |