Healthcare Provider Details

I. General information

NPI: 1124463435
Provider Name (Legal Business Name): JOHN T VANWEY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 DUFF ST
GAMBIER OH
43022-5013
US

IV. Provider business mailing address

5450 FRANTZ RD STE 250
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 740-427-5224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT013002
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT002867
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: