Healthcare Provider Details

I. General information

NPI: 1184682932
Provider Name (Legal Business Name): BELLEFONTAINE PHYSICAL THERAPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 RUSH AVE
BELLEFONTAINE OH
43311
US

IV. Provider business mailing address

711 RUSH AVE
BELLEFONTAINE OH
43311
US

V. Phone/Fax

Practice location:
  • Phone: 937-592-1625
  • Fax: 937-592-3489
Mailing address:
  • Phone: 937-592-1625
  • Fax: 937-592-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RODNEY A KEVUS
Title or Position: OWNER
Credential: PT
Phone: 937-592-1625