1639142029 NPI number — CHOICE PHYSICAL THERAPY OF OHIO LLC

Table of content: (NPI 1639142029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639142029 NPI number — CHOICE PHYSICAL THERAPY OF OHIO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICE PHYSICAL THERAPY OF OHIO 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:
1639142029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9419 KENWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-6811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-792-0777
Provider Business Mailing Address Fax Number:
513-792-0061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9419 KENWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242-6811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-792-0777
Provider Business Practice Location Address Fax Number:
513-792-0061
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAIR
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
513-792-0777

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300563892002 . This is a "MEDICAL MUTUAL W" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9603 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 270828495001 . This is a "MEDICAL MUTUAL G" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 650023013 . This is a "RR MEDICARE PTAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000178624 . This is a "ANTHEM PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: CJ9603 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 269528041004 . This is a "MEDICAL MUTUAL B" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00611846 . This is a "RR MEDICARE PTAN (3)" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00434380 . This is a "RR MEDICARE PTAN (2)" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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