1215948302 NPI number — ARCHBOLD PHYSICAL THERAPY SERVICES, INC.

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 1215948302 NPI number — ARCHBOLD PHYSICAL THERAPY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCHBOLD PHYSICAL THERAPY SERVICES, INC.
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:
1215948302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 EAST LUTZ ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARCHBOLD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-446-9144
Provider Business Mailing Address Fax Number:
419-466-9146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 EAST LUTZ ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCHBOLD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-446-9144
Provider Business Practice Location Address Fax Number:
419-466-9146
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIEDEMAN
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHYSICAL THERAPIST PRESIDENT
Authorized Official Telephone Number:
419-446-9144

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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