Healthcare Provider Details

I. General information

NPI: 1194382424
Provider Name (Legal Business Name): ABOVE AND BEYOND THERAPY OH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

20 S 3RD ST STE 210
COLUMBUS OH
43215-4206
US

IV. Provider business mailing address

185 ROUTE 70 STE 302
TOMS RIVER NJ
08755-0936
US

V. Phone/Fax

Practice location:
  • Phone: 732-806-0091
  • Fax: 732-813-8001
Mailing address:
  • Phone: 732-806-0091
  • Fax: 732-813-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. MATT ROKOWSKY
Title or Position: DIRECTOR
Credential:
Phone: 732-806-0091