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General NPI Number Information
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NPI Number | 1871929323
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Entity Type | Organization
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Legal Business Name | ON THE GO THERAPY LLC
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 109 N MAIN ST #102
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City | MANSFIELD
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State | OH
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Zip | 44902-7669
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Country | US
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Telephone | 330-347-6685
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Fax |
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Provider Business Mailing Address
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Address Line | 109 N MAIN ST #102
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City | MANSFIELD
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State | OH
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Zip | 44902-7669
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Country | US
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Telephone | 330-347-6685
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | KAREN ANNE FRONTZ
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Credential |
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Telephone | 330-347-6685
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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 | 2210865
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License Number State | OH
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