Provider Demographics
NPI:1548630981
Name:EISENHUTH, SARA JAYNE (PTA)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JAYNE
Last Name:EISENHUTH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OH
Mailing Address - Zip Code:44081-9575
Mailing Address - Country:US
Mailing Address - Phone:440-537-7955
Mailing Address - Fax:
Practice Address - Street 1:470 CENTER ST
Practice Address - Street 2:#2
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1098
Practice Address - Country:US
Practice Address - Phone:440-279-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08909225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant