MEDICARE: THERASPORT PHYSICAL THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013044569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERASPORT PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	3425 EXECUTIVE PKWY
Second Line	:	SUITE 128
City	:	TOLEDO
State	:	OH
Zip	:	43606-1326
Country	:	US
Telephone Number	:	419-252-5541
Fax Number	:	419-252-5548

Provider Business Practice Location Address
First Line	:	6543 MIDDLEBELT RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2145
Country	:	US
Telephone Number	:	734-458-7878
Fax Number	:	734-458-7838

Authorized Official
Title or Position	:	VICE PRESIDENT - REIMBURSEMENTS
Name	:	MR. BARRY A LAZARUS
Credential	:
Telephone Number	:	419-252-5541

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/22/2020

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