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General NPI Number Information
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NPI Number | 1154502409
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Entity Type | Organization
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Legal Business Name | EDELSTEIN PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 02/20/2016
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Provider Practice Location Address
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Address Line | 9549 MONTGOMERY RD SUITE 100
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City | CINCINNATI
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State | OH
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Zip | 45242-7238
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Country | US
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Telephone | 513-884-4664
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Fax | 513-489-1266
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Provider Business Mailing Address
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Address Line | 11992 BARNESWOOD CT
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City | CINCINNATI
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State | OH
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Zip | 45249-1301
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Country | US
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Telephone | 513-884-4664
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Fax | 513-489-1266
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Authorized Official
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Title or Position | OWNER
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Name | MS. LAURA EDELSTEIN MENDELSON
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Credential | PT
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Telephone | 513-884-4664
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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 | 006165
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 007027
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 02920
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License Number State | OH
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