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General NPI Number Information
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NPI Number | 1619862463
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Entity Type | Organization
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Legal Business Name | 3 PHASE PERFORMANCE THERAPY AND SPORTS
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 11154 ROAD 230
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City | CECIL
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State | OH
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Zip | 45821-9309
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Country | US
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Telephone | 419-438-5026
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Fax | 419-438-5026
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Provider Business Mailing Address
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Address Line | 11154 ROAD 230
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City | CECIL
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State | OH
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Zip | 45821-9309
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Country | US
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Telephone | 419-438-5026
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Fax | 419-438-5026
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Authorized Official
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Title or Position | OWNER
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Name | SETH M BIDLACK
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Credential | OT
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Telephone | 419-438-5024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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