Provider Demographics
NPI:1073054219
Name:PERRYSBURG THERAPY LLC
Entity Type:Organization
Organization Name:PERRYSBURG THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-931-3020
Mailing Address - Street 1:830 W SOUTH BOUNDARY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5238
Mailing Address - Country:US
Mailing Address - Phone:419-931-3020
Mailing Address - Fax:419-931-3022
Practice Address - Street 1:830 W SOUTH BOUNDARY ST
Practice Address - Street 2:SUITE A
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5238
Practice Address - Country:US
Practice Address - Phone:419-931-3020
Practice Address - Fax:419-931-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1600096101YM0800X
OHC1300382101YM0800X
OHE1700029101YM0800X
OHI-000-5829-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty