Healthcare Provider Details

I. General information

NPI: 1336890987
Provider Name (Legal Business Name): LIFT PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 MONTGOMERY RD
MONTGOMERY OH
45242-5322
US

IV. Provider business mailing address

2247 STATE ROUTE 132
GOSHEN OH
45122-9714
US

V. Phone/Fax

Practice location:
  • Phone: 513-800-0848
  • Fax:
Mailing address:
  • Phone: 513-652-9652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREA REED
Title or Position: OWNER
Credential: DPT
Phone: 513-652-9652