Healthcare Provider Details

I. General information

NPI: 1962634683
Provider Name (Legal Business Name): MID-OHIO IN HOME PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N MAIN ST
MT GILEAD OH
43338-1115
US

IV. Provider business mailing address

206 N MAIN ST
MT GILEAD OH
43338-1115
US

V. Phone/Fax

Practice location:
  • Phone: 419-948-0144
  • Fax: 419-946-6609
Mailing address:
  • Phone: 419-948-0144
  • Fax: 419-946-6609

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: MR. ERIC RICHARD KEIPER
Title or Position: OWNER
Credential: PT
Phone: 419-948-0144