Healthcare Provider Details

I. General information

NPI: 1114447901
Provider Name (Legal Business Name): NICHOLAS HESS PT, DPT, CSCS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SUGAR CAMP CIR STE 110
OAKWOOD OH
45409-1979
US

IV. Provider business mailing address

105 SUGAR CAMP CIR STE 110
OAKWOOD OH
45409-1979
US

V. Phone/Fax

Practice location:
  • Phone: 937-227-3174
  • Fax: 937-227-3174
Mailing address:
  • Phone: 937-227-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT016910
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: