Healthcare Provider Details

I. General information

NPI: 1003467630
Provider Name (Legal Business Name): ETHAN DANIEL LAUNSTEIN PT, DPT, AT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 WINSLOW AVE
CINCINNATI OH
45206-1144
US

IV. Provider business mailing address

584 E COLUMBIA RD
MASON MI
48854-9647
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-3200
  • Fax:
Mailing address:
  • Phone: 517-525-1679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: