Healthcare Provider Details

I. General information

NPI: 1194485367
Provider Name (Legal Business Name): OMSPT HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14561 JETPORT LOOP; BLDG #200. SUITE 135 JETPORT COMMERCE PARK
FORT MYERS FL
33913-3391
US

IV. Provider business mailing address

1212 BATH AVE STE 350
ASHLAND KY
41101-2696
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-0540
  • Fax: 606-324-0616
Mailing address:
  • Phone: 606-324-0540
  • Fax: 606-324-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY S RITCHEY
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 606-324-0540