Healthcare Provider Details

I. General information

NPI: 1679652325
Provider Name (Legal Business Name): MIDWEST THERAPY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 WILMINGTON PIKE
KETTERING OH
45429-4004
US

IV. Provider business mailing address

3122 WILMINGTON PIKE
KETTERING OH
45429-4004
US

V. Phone/Fax

Practice location:
  • Phone: 937-299-9337
  • Fax: 937-299-9227
Mailing address:
  • Phone: 937-299-9337
  • Fax: 937-299-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JESSI LEE
Title or Position: HR COORDINATOR
Credential:
Phone: 937-299-9337