Individual
MR. JEFFREY LYNN REALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
850 W MAPLE ST, HARTVILLE, OH 44632-9668
(330) 877-3488
(330) 877-4147
Mailing address
4645 BELPAR ST NW, CANTON, OH 44718-3602
(330) 493-4210
(330) 493-4744
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 004856
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000134699
ANTHEM BC/BS
OH
Enumeration date
07/26/2006
Last updated
07/08/2007
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