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General NPI Number Information
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NPI Number | 1063307320
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Entity Type | Organization
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Legal Business Name | OBSIDIAN PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 267 W NATIONAL RD
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City | VANDALIA
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State | OH
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Zip | 45377
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Country | US
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Telephone | 937-400-1155
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Fax |
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Provider Business Mailing Address
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Address Line | 5636 BELLEFONTAINE RD
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-4135
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Country | US
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Telephone | 317-385-6332
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | DR. NINA BENDIXEN
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Credential | PT, DPT
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Telephone | 317-385-6332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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