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General NPI Number Information
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NPI Number | 1790288983
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Entity Type | Organization
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Legal Business Name | IMPACT PERFORMANCE THERAPY
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 21 W COLUMBUS ST
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City | COLUMBUS
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State | OH
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Zip | 43229-1055
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Country | US
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Telephone | 717-599-0131
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 HILL RD N PMB 321
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City | PICKERINGTON
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State | OH
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Zip | 43147
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Country | US
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Telephone | 717-599-0131
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, PHYSICAL THERAPIST
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Name | DR. ANTHONY S FARINA
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Credential | PT, DPT, MS, CSCS
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Telephone | 717-599-0131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT016748
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License Number State | OH
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