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NPI Code Detail

MEDICARE: DEREK KARL KAUTZMANN MPT

MEDICARE: DEREK KARL KAUTZMANN MPT
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
1174400000XSpecialist010701OH
22251X0800XOrthopedic Physical Therapist010701OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1010701OTHEROHOH PT LICENSE

General Provider Information

NPI Number : 1194797506
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK KARL KAUTZMANN MPT
Provider Business Mailing Address
First Line : 6350 GLENWAY AVE
Second Line : SUITE 415
City : CINCINNATI
State : OH
Zip : 45211-6378
Country : US
Telephone Number : 513-347-9999
Fax Number : 513-347-3999
Provider Business Practice Location Address
First Line : 6350 GLENWAY AVE
Second Line : SUITE 415
City : CINCINNATI
State : OH
Zip : 45211-6378
Country : US
Telephone Number : 513-347-9999
Fax Number : 513-347-3999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 01/02/2014

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