Provider Demographics
NPI:1114562295
Name:YOUR THERAPY COMPANY
Entity Type:Organization
Organization Name:YOUR THERAPY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUSIC
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:419-747-9919
Mailing Address - Street 1:1159 WYANDOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1940
Mailing Address - Country:US
Mailing Address - Phone:419-747-9919
Mailing Address - Fax:
Practice Address - Street 1:1159 WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1940
Practice Address - Country:US
Practice Address - Phone:419-747-9919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy