Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT09270 | OH |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT09270 | OH |
NPI | 1215023072 |
---|---|
Provider Name | Mr. Marc Anthony Vasil |
First Address | Chagrin Falls, OH 44023-1625 |
Second Address | Mayfield Heights, OH 44124-2932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 16/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2303715 | (05) | OH |