Healthcare Provider Details

I. General information

NPI: 1639635733
Provider Name (Legal Business Name): ATHENA THERAPY HOLDINGS CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 YOUNGSTOWN WARREN RD STE B
NILES OH
44446-4649
US

IV. Provider business mailing address

4293 COLUMBIA RD
MEDINA OH
44256-7707
US

V. Phone/Fax

Practice location:
  • Phone: 330-989-3893
  • Fax:
Mailing address:
  • Phone: 330-410-3982
  • Fax: 330-451-5700

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: TERESA BRADFORD
Title or Position: PRESIDENT
Credential:
Phone: 330-410-3982