Healthcare Provider Details

I. General information

NPI: 1124347737
Provider Name (Legal Business Name): ALL STAR PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 W 27TH ST
ASHTABULA OH
44004-4975
US

IV. Provider business mailing address

416 W 27TH ST
ASHTABULA OH
44004-4975
US

V. Phone/Fax

Practice location:
  • Phone: 440-650-1884
  • Fax: 440-997-5486
Mailing address:
  • Phone: 440-650-1884
  • Fax: 440-997-5486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TRACY MARVIN
Title or Position: BILLING AND CREDENTIALING
Credential:
Phone: 404-650-1884