MEDICARE: PREMIER THERAPY CENTER LLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1790548295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER THERAPY CENTER LLC

Provider Business Mailing Address
First Line	:	3431 CLEVELAND AVE STE G
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-2920
Country	:	US
Telephone Number	:	614-403-1923
Fax Number	:

Provider Business Practice Location Address
First Line	:	3431 CLEVELAND AVE STE G
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-2920
Country	:	US
Telephone Number	:	614-403-1923
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY R SMITH
Credential	:	DC
Telephone Number	:	614-403-1923

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/06/2024

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