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General NPI Number Information
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NPI Number | 1689924714
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Entity Type | Organization
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Legal Business Name | ALLIED THERAPY EAST
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 170 MILL ST
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City | GAHANNA
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State | OH
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Zip | 43230-3036
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Country | US
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Telephone | 614-414-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 170 MILL ST
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City | GAHANNA
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State | OH
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Zip | 43230-3036
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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 | CLINIC DIRECTOR
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Name | TRACY DHAYER
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Credential |
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Telephone | 61441402803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT.013922
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License Number State | OH
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