Healthcare Provider Details

I. General information

NPI: 1174117584
Provider Name (Legal Business Name): CASANOVA PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 04/20/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6631 COMMERCE PKWY STE K
DUBLIN OH
43017-3239
US

IV. Provider business mailing address

6631 COMMERCE PKWY STE K
DUBLIN OH
43017-3239
US

V. Phone/Fax

Practice location:
  • Phone: 614-779-3646
  • Fax:
Mailing address:
  • Phone: 614-389-0285
  • Fax: 614-389-0285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. SANTIAGO CASANOVA
Title or Position: OWNER, PT
Credential: PT
Phone: 614-389-0285