Healthcare Provider Details

I. General information

NPI: 1093795346
Provider Name (Legal Business Name): DOUGLAS G PATCH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 OLENTANGY RIVER RD
COLUMBUS OH
43212-3129
US

IV. Provider business mailing address

1313 OLENTANGY RIVER RD
COLUMBUS OH
43212-3129
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-6555
  • Fax: 614-823-7075
Mailing address:
  • Phone: 614-890-6555
  • Fax: 614-823-7075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT03516
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: