MEDICARE: ORTHO ADVANTAGE 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	261QP2000X	Physical Therapy Clinic/Center
2	225100000X	Physical Therapist	PT005978	OH

General Provider Information

NPI Number	:	1104846021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO ADVANTAGE LLC

Provider Business Mailing Address
First Line	:	8200 WASHINGTON VILLAGE DR
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1850
Country	:	US
Telephone Number	:	937-434-4141
Fax Number	:	937-431-9100

Provider Business Practice Location Address
First Line	:	8200 WASHINGTON VILLAGE DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1850
Country	:	US
Telephone Number	:	937-434-4141
Fax Number	:	937-431-9100

Authorized Official
Title or Position	:	OWNER
Name	:	JAMI WITHROW
Credential	:
Telephone Number	:	937-434-4141

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/13/2024

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Directions to “ORTHO ADVANTAGE LLC ” Practice Location

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