Healthcare Provider Details

I. General information

NPI: 1972818037
Provider Name (Legal Business Name): PT WORKS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 LANTERMAN RD
AUSTINTOWN OH
44515-1434
US

IV. Provider business mailing address

4307 LANTERMAN RD
AUSTINTOWN OH
44515-1434
US

V. Phone/Fax

Practice location:
  • Phone: 330-559-9179
  • Fax: 330-965-6476
Mailing address:
  • Phone: 330-559-9179
  • Fax: 330-965-6476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number04983
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9056
License Number StateOH

VIII. Authorized Official

Name: MRS. AMANDA RAE MILLER
Title or Position: LPTA, PRESIDENT
Credential:
Phone: 330-559-9179