=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588336762
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHIO INJURY AND REHABILITATION LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2021
-----------------------------------------------------
Last Update Date | 10/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1812 PEARL RD
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44212-3252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-609-5533
-----------------------------------------------------
Fax | 330-609-5553
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1812 PEARL RD
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44212-3252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-609-5533
-----------------------------------------------------
Fax | 330-609-5553
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGEMENT
-----------------------------------------------------
Name | THERESA BABBO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-609-5533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------