Healthcare Provider Details

I. General information

NPI: 1215948302
Provider Name (Legal Business Name): ARCHBOLD PHYSICAL THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 EAST LUTZ ROAD
ARCHBOLD OH
43502
US

IV. Provider business mailing address

815 EAST LUTZ ROAD
ARCHBOLD OH
43502
US

V. Phone/Fax

Practice location:
  • Phone: 419-446-9144
  • Fax: 419-466-9146
Mailing address:
  • Phone: 419-446-9144
  • Fax: 419-466-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAMELA J RIEDEMAN
Title or Position: PHYSICAL THERAPIST PRESIDENT
Credential: PT MA
Phone: 419-446-9144