Healthcare Provider Details

I. General information

NPI: 1497074702
Provider Name (Legal Business Name): ANDREW R HABASH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E BUSINESS WAY SUITE C
CINCINNATI OH
45241-2374
US

IV. Provider business mailing address

6480 HARRISON AVE SUITE 201
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 513-389-3666
  • Fax: 513-389-3665
Mailing address:
  • Phone: 513-354-7785
  • Fax: 513-354-7651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12646
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number015162
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: