Healthcare Provider Details

I. General information

NPI: 1568604148
Provider Name (Legal Business Name): MONTY BACKUS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 MONTGOMERY RD
CINCINNATI OH
45236-2227
US

IV. Provider business mailing address

8311 MONTGOMERY RD
CINCINNATI OH
45236-2227
US

V. Phone/Fax

Practice location:
  • Phone: 513-985-3700
  • Fax: 513-985-3706
Mailing address:
  • Phone: 513-985-3700
  • Fax: 513-985-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008905
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: