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General NPI Number Information
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NPI Number | 1659638518
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Entity Type | Organization
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Legal Business Name | FISHER TITUS MEDICAL CENTER
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Dates
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Enumeration Date | 04/17/2012
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Last Update Date | 04/17/2012
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Provider Practice Location Address
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Address Line | 272 BENEDICT AVE
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City | NORWALK
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State | OH
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Zip | 44857-2374
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Country | US
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Telephone | 419-668-8101
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Fax |
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Provider Business Mailing Address
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Address Line | 272 BENEDICT AVE
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City | NORWALK
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State | OH
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Zip | 44857-2374
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Country | US
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Telephone | 419-668-8101
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Fax |
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Authorized Official
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Title or Position | STAFF ATHLETIC TRAINER
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Name | MR. ROBERT N. WHITEHURST II
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Credential | ATC
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Telephone | 419-744-0929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | AT.003664
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License Number State | OH
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