Healthcare Provider Details

I. General information

NPI: 1821523416
Provider Name (Legal Business Name): SHORT NORTH PEAK PERFORMANCE & PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 HAMLET ST
COLUMBUS OH
43201-3588
US

IV. Provider business mailing address

1054 HAMLET ST
COLUMBUS OH
43201-3588
US

V. Phone/Fax

Practice location:
  • Phone: 574-276-5617
  • Fax:
Mailing address:
  • Phone: 574-276-5617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number201700201410
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number201700201410
License Number StateOH

VIII. Authorized Official

Name: DR. ERIKA LYNNE PATTERSON
Title or Position: DR. OF PHYSICAL THERAPY
Credential: DPT
Phone: 574-276-5617