Healthcare Provider Details

I. General information

NPI: 1154804433
Provider Name (Legal Business Name): MINDY HAREN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3773 OLENTANGY RIVER RD
COLUMBUS OH
43214-3425
US

IV. Provider business mailing address

1527 WESTWOOD DR
LEWIS CENTER OH
43035-6071
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-3810
  • Fax:
Mailing address:
  • Phone: 614-288-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11671
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: