Healthcare Provider Details

I. General information

NPI: 1487687125
Provider Name (Legal Business Name): NORTHWEST PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 N PERRY ST SUITE 100
OTTAWA OH
45875-1129
US

IV. Provider business mailing address

1880 N PERRY ST SUITE 100
OTTAWA OH
45875-1129
US

V. Phone/Fax

Practice location:
  • Phone: 419-523-9003
  • Fax: 419-523-9143
Mailing address:
  • Phone: 419-523-9003
  • Fax: 419-523-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD HANNEMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 419-523-9003