Provider Demographics
NPI:1144521360
Name:GERMEK, COLETTA SUE (DPT)
Entity type:Individual
Prefix:
First Name:COLETTA
Middle Name:SUE
Last Name:GERMEK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:COLETTA
Other - Middle Name:SUE
Other - Last Name:MACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:14027 MAYFIELD RD
Mailing Address - Street 2:PO BOX 346
Mailing Address - City:EAST CLARIDON
Mailing Address - State:OH
Mailing Address - Zip Code:44033
Mailing Address - Country:US
Mailing Address - Phone:440-635-0144
Mailing Address - Fax:
Practice Address - Street 1:348 W MAIN RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2063
Practice Address - Country:US
Practice Address - Phone:440-635-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist