Healthcare Provider Details

I. General information

NPI: 1154502409
Provider Name (Legal Business Name): EDELSTEIN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 02/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9549 MONTGOMERY RD SUITE 100
CINCINNATI OH
45242-7238
US

IV. Provider business mailing address

11992 BARNESWOOD CT
CINCINNATI OH
45249-1301
US

V. Phone/Fax

Practice location:
  • Phone: 513-884-4664
  • Fax: 513-489-1266
Mailing address:
  • Phone: 513-884-4664
  • Fax: 513-489-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number02920
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006165
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number007027
License Number StateKY

VIII. Authorized Official

Name: MS. LAURA EDELSTEIN MENDELSON
Title or Position: OWNER
Credential: PT
Phone: 513-884-4664