Healthcare Provider Details

I. General information

NPI: 1588636849
Provider Name (Legal Business Name): FT RECOVERY FAMILY MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 BLUE JACKET DRIVE
FORT RECOVERY OH
45846
US

IV. Provider business mailing address

807 BLUE JACKET DRIVE
FORT RECOVERY OH
45846
US

V. Phone/Fax

Practice location:
  • Phone: 419-375-2112
  • Fax: 417-375-7003
Mailing address:
  • Phone: 419-375-2122
  • Fax: 419-375-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI A ROHRER
Title or Position: MANAGER/OWNER
Credential:
Phone: 419-375-2122