MEDICARE: SURMOUNT FITNESS AND PERFORMANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1063018364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURMOUNT FITNESS AND PERFORMANCE

Provider Business Mailing Address
First Line	:	804 LORY LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-4941
Country	:	US
Telephone Number	:	708-567-2359
Fax Number	:

Provider Business Practice Location Address
First Line	:	7051 YANKEE RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9132
Country	:	US
Telephone Number	:	513-445-8524
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	BRIAN EDWARD BARNEY
Credential	:	PT, DPT, CSCS
Telephone Number	:	708-567-2359

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	12/26/2022

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Directions to “SURMOUNT FITNESS AND PERFORMANCE ” Practice Location

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