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General NPI Number Information
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NPI Number | 1982721171
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Entity Type | Organization
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Legal Business Name | MIDWEST SPORTS THERAPY
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4453 STATE ROUTE 159
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-8620
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Country | US
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Telephone | 740-775-7722
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Fax | 740-775-7732
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Provider Business Mailing Address
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Address Line | 4453 STATE ROUTE 159
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-8620
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Country | US
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Telephone | 740-775-7722
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Fax | 740-775-7732
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRIAN J FULLER
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Credential | PT
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Telephone | 740-775-7722
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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 |
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License Number State |
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