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General NPI Number Information
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NPI Number | 1568352631
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Entity Type | Organization
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Legal Business Name | INFORM PHYSICAL THERAPY AND WELLNESS LLC
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 8379 YANKEE ST
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City | DAYTON
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State | OH
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Zip | 45458-1810
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Country | US
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Telephone | 513-324-1923
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Fax |
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Provider Business Mailing Address
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Address Line | 9808 BLUE SPRUCE DR
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City | SPRINGBORO
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State | OH
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Zip | 45066-5010
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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/PHYSICAL THERAPIST
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Name | CHARLOTTE LANGE
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Credential |
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Telephone | 513-324-1923
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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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