1134107568 NPI number — BEAVERCREEK HAND AND BODY THERAPY

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 1134107568 NPI number — BEAVERCREEK HAND AND BODY THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAVERCREEK HAND AND BODY THERAPY
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:
1134107568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPHA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45301-0140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-478-4210
Provider Business Mailing Address Fax Number:
866-272-1218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 XENIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YELLOW SPRINGS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45387-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-478-4210
Provider Business Practice Location Address Fax Number:
866-272-1218
Provider Enumeration Date:
01/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRUHOT
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
937-478-4210

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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