Basic Information
| Provider Information | |||||||||
| NPI: | 1023134954 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWEENEY-MARTIN | ||||||||
| FirstName: | FERN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37094 | ||||||||
| Address2: | |||||||||
| City: | MAPLE HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441370094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169709418 | ||||||||
| FaxNumber: | 2169010401 | ||||||||
| Practice Location | |||||||||
| Address1: | 20265 EMERY RD | ||||||||
| Address2: | |||||||||
| City: | NORTH RANDALL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441284122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164758880 | ||||||||
| FaxNumber: | 2165874806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 12/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 00435 | OH | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2073007 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.