=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972505576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | P.T. SERVICES REHABILITATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2005
-----------------------------------------------------
Last Update Date | 02/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 805 PATRIOT DRIVE SUITE H
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44090-8951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-447-7203
-----------------------------------------------------
Fax | 419-447-5577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 PATRIOT DRIVE SUITE H
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44090-8951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-447-7203
-----------------------------------------------------
Fax | 419-447-5577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. MARK STEPHEN SOMODI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-447-7203
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------