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NPI Code Detail

MEDICARE: KETTERING PHYSIATRISTS, INC.

MEDICARE: KETTERING PHYSIATRISTS, 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
1208100000XPhysical Medicine & Rehabilitation Physician35038579POH

General Provider Information

NPI Number : 1902893035
Entity Type Code : Organization
Provider Name (Legal Business Name) : KETTERING PHYSIATRISTS, INC.
Provider Business Mailing Address
First Line : PO BOX 750245
Second Line :
City : DAYTON
State : OH
Zip : 45475-0245
Country : US
Telephone Number : 937-438-9500
Fax Number : 937-438-9075
Provider Business Practice Location Address
First Line : 3535 SOUTHERN BLVD
Second Line :
City : KETTERING
State : OH
Zip : 45429-1221
Country : US
Telephone Number : 937-395-8666
Fax Number : 937-395-8090
Authorized Official
Title or Position : PRESIDENT
Name : JOHN PETTY
Credential : MD
Telephone Number : 937-395-8666
Provider Enumeration Date : 10/04/2005
Last Update Date : 08/22/2020

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Directions to “KETTERING PHYSIATRISTS, INC. ” Practice Location

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