Healthcare Provider Details

I. General information

NPI: 1811976228
Provider Name (Legal Business Name): STAR PT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 W US RT 224
TIFFIN OH
44883
US

IV. Provider business mailing address

3101 W US RT 224
TIFFIN OH
44883
US

V. Phone/Fax

Practice location:
  • Phone: 419-443-1429
  • Fax: 419-443-1691
Mailing address:
  • Phone: 419-443-1429
  • Fax: 419-443-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: TERRY L JOLLIFF
Title or Position: DIRECTOR/MPT
Credential: MPT
Phone: 419-443-1429