1366673709 NPI number — ONSITE THERAPY RESOURCES LLC

Table of content: (NPI 1366673709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366673709 NPI number — ONSITE THERAPY RESOURCES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONSITE THERAPY RESOURCES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366673709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 144
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43086-0144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-890-3676
Provider Business Mailing Address Fax Number:
614-890-2952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
839 FORTUNEGATE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43081-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-890-3676
Provider Business Practice Location Address Fax Number:
614-890-2953
Provider Enumeration Date:
08/03/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WENDELL
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
614-890-3676

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  006227 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)