Healthcare Provider Details

I. General information

NPI: 1518293042
Provider Name (Legal Business Name): AVIDA PT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2009
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1391 DUBLIN RD
COLUMBUS OH
43215-1084
US

IV. Provider business mailing address

1391 DUBLIN RD
COLUMBUS OH
43215-1084
US

V. Phone/Fax

Practice location:
  • Phone: 614-487-9715
  • Fax: 614-487-9716
Mailing address:
  • Phone: 614-487-9715
  • Fax: 614-487-9716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1886429
License Number StateOH

VIII. Authorized Official

Name: CAROL SAUER ALBRIGHT
Title or Position: 0WNER
Credential:
Phone: 614-561-5560