Provider Demographics
NPI:1003388620
Name:THERA MED LLC.
Entity Type:Organization
Organization Name:THERA MED LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:CLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-841-2298
Mailing Address - Street 1:6500 W CENTRAL AVE # D-2
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1031
Mailing Address - Country:US
Mailing Address - Phone:419-841-2298
Mailing Address - Fax:419-841-7245
Practice Address - Street 1:6500 W CENTRAL AVE # D-2
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1031
Practice Address - Country:US
Practice Address - Phone:419-841-2298
Practice Address - Fax:419-841-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty