Healthcare Provider Details

I. General information

NPI: 1528041274
Provider Name (Legal Business Name): MARYSVILLE PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 STOCKSDALE DR
MARYSVILLE OH
43040-5507
US

IV. Provider business mailing address

211 STOCKSDALE DR
MARYSVILLE OH
43040-5507
US

V. Phone/Fax

Practice location:
  • Phone: 937-644-3311
  • Fax: 937-644-0373
Mailing address:
  • Phone: 937-644-3311
  • Fax: 937-644-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number9611000450
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 004515
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 004515
License Number StateOH

VIII. Authorized Official

Name: SHERRY L WOOD
Title or Position: OFFICE MANAGER
Credential:
Phone: 937-644-3311