1053457002 NPI number — LETS GET PHYSICAL THERAPY GROUP LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053457002 NPI number — LETS GET PHYSICAL THERAPY GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LETS GET PHYSICAL THERAPY GROUP 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:
1053457002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35840 CHESTER RD STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44011-1240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-937-5210
Provider Business Mailing Address Fax Number:
440-937-5212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35840 CHESTER RD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44011-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-937-5210
Provider Business Practice Location Address Fax Number:
440-937-5212
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RIMKO
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
WHIPPLE
Authorized Official Title or Position:
OWNER SENIOR PHYSICAL THERAPIST
Authorized Official Telephone Number:
440-937-5210

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 06140 , 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)

  • Identifier: 2617010 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 378168 . This is a "ANTHEM BC BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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