Healthcare Provider Details

I. General information

NPI: 1912329087
Provider Name (Legal Business Name): OHIO CHOICE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 06/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 S HIGH ST
COLUMBUS OH
43207-1045
US

IV. Provider business mailing address

1430 S HIGH ST
COLUMBUS OH
43207-1045
US

V. Phone/Fax

Practice location:
  • Phone: 614-444-5340
  • Fax: 614-444-5342
Mailing address:
  • Phone: 614-444-5340
  • Fax: 614-444-5342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number007723
License Number StateOH

VIII. Authorized Official

Name: LISA SYAM
Title or Position: MANAGER
Credential:
Phone: 614-517-0661