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General NPI Number Information
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NPI Number | 1528785136
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Entity Type | Organization
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Legal Business Name | RESILIENT PHYSICAL THERAPY & WELLNESS
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 711 W WENGER RD APT 205
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City | ENGLEWOOD
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State | OH
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Zip | 45322-1920
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Country | US
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Telephone | 937-670-6922
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Fax |
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Provider Business Mailing Address
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Address Line | 711 W WENGER RD APT 205
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City | ENGLEWOOD
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State | OH
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Zip | 45322-1920
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Country | US
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Telephone | 937-670-6922
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JORDAN BEVINS
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Credential | PT, DPT
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Telephone | 937-670-6922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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