MEDICARE: THE THERAPY SOURCE, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1083138705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE THERAPY SOURCE, INC.

Provider Business Mailing Address
First Line	:	6480 HARRISON AVE STE 301
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7961
Country	:	US
Telephone Number	:	513-574-5400
Fax Number	:	513-574-6222

Provider Business Practice Location Address
First Line	:	2835 MIAMI VILLAGE DR
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-4587
Country	:	US
Telephone Number	:	513-574-5400
Fax Number	:	513-574-6222

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MINDY HEIL
Credential	:
Telephone Number	:	513-574-5400

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	08/03/2017

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