1740288919 NPI number — UNIVERSAL THERAPY DYNAMICS, INC

Table of content: (NPI 1740288919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740288919 NPI number — UNIVERSAL THERAPY DYNAMICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSAL THERAPY DYNAMICS, 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:
1740288919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35000 KAISER CT
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
WILLOUGHBY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44094-3382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-951-6677
Provider Business Mailing Address Fax Number:
440-951-2820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35000 KAISER CT
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
WILLOUGHBY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44094-3382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-951-6677
Provider Business Practice Location Address Fax Number:
440-951-2820
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LIUZZO
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-951-6677

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , 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: 2660893 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000166005 . This is a "ANTHEM PT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000287889 . This is a "ANTHEM OT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2660973 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6400134 . This is a "UNITED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 100644 . This is a "KAISER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 127841100 . This is a "DOL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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