Healthcare Provider Details

I. General information

NPI: 1053315911
Provider Name (Legal Business Name): CHARLES P CONTI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10547 MONTGOMERY RD STE 700
CINCINNATI OH
45242-4418
US

IV. Provider business mailing address

694 AUSTRIAN CT
MILFORD OH
45150-6566
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-4600
  • Fax: 513-936-3493
Mailing address:
  • Phone: 513-575-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT03589
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: