=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023636792
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GET BACK PHYSIO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2020
-----------------------------------------------------
Last Update Date | 10/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3246 W HENDERSON RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-353-1581
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 580 THORNGATE CT
-----------------------------------------------------
City | GALLOWAY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43119-8324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-353-1581
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GINA KIM
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 614-353-1581
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------