Provider Demographics
NPI:1104846021
Name:ORTHO ADVANTAGE LLC
Entity Type:Organization
Organization Name:ORTHO ADVANTAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:937-434-4141
Mailing Address - Street 1:6560 CENTERVILLE BUSINESS PKWY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2685
Mailing Address - Country:US
Mailing Address - Phone:937-434-4141
Mailing Address - Fax:937-431-9100
Practice Address - Street 1:6560 CENTERVILLE BUSINESS PKWY
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2685
Practice Address - Country:US
Practice Address - Phone:937-434-4141
Practice Address - Fax:937-431-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT005978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX
OH4176871Medicare PIN