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General NPI Number Information
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NPI Number | 1508650664
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Entity Type | Organization
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Legal Business Name | CITIUS PERFORMANCE THERAPY
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Dates
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Enumeration Date | 04/05/2025
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Last Update Date | 04/05/2025
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Provider Practice Location Address
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Address Line | 6545 MARKET AVE N STE 100
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City | CANTON
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State | OH
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Zip | 44721-2430
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Country | US
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Telephone | 614-961-0273
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Fax |
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Provider Business Mailing Address
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Address Line | 6545 MARKET AVE N STE 100
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City | CANTON
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State | OH
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Zip | 44721-2430
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENT MITCHELL FORD
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Credential | PT, DPT, MS
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Telephone | 614-961-0273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 226300000X
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Taxonomy Name | Kinesiotherapist
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License Number |
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License Number State |
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Taxonomy #3
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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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