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General NPI Number Information
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NPI Number | 1750782074
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Entity Type | Organization
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Legal Business Name | IN HOME PEDIATRIC PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 09/05/2014
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Provider Practice Location Address
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Address Line | 2468 DYSART RD
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City | UNIVERSITY HEIGHTS
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State | OH
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Zip | 44118-4445
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Country | US
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Telephone | 502-510-5297
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Fax | 801-681-0724
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Provider Business Mailing Address
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Address Line | 2468 DYSART RD
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City | UNIVERSITY HEIGHTS
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State | OH
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Zip | 44118-4445
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Country | US
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Telephone | 502-510-5297
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Fax | 801-681-0724
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Authorized Official
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Title or Position | ROSE DUES, PT
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Name | ROSE DUES
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Credential | P.T.
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Telephone | 502-510-5297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 012483
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License Number State | OH
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