MEDICARE: IMPOWER THERAPY, LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1104410463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPOWER THERAPY, LLC

Provider Business Mailing Address
First Line	:	12790 TR 25
Second Line	:
City	:	ARLINGTON
State	:	OH
Zip	:	45814-9702
Country	:	US
Telephone Number	:	419-957-9852
Fax Number	:

Provider Business Practice Location Address
First Line	:	12790 TR 25
Second Line	:
City	:	ARLINGTON
State	:	OH
Zip	:	45814-9702
Country	:	US
Telephone Number	:	419-957-9852
Fax Number	:

Authorized Official
Title or Position	:	OWNER OPERATOR
Name	:	MRS. MELINDA E BAKER
Credential	:	PT, MPT
Telephone Number	:	419-957-9852

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	02/25/2021

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Directions to “IMPOWER THERAPY, LLC ” Practice Location

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