Healthcare Provider Details

I. General information

NPI: 1548438500
Provider Name (Legal Business Name): ERIK W HEMENWAY PTA, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 KENNY RD SUITE 3100
COLUMBUS OH
43221-3502
US

IV. Provider business mailing address

920 N HAMILTON RD SUITE 600
GAHANNA OH
43230-1757
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3600
  • Fax: 614-293-4399
Mailing address:
  • Phone: 614-293-7600
  • Fax: 614-293-7540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.07472
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06003631A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001444A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.003322
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: