Provider Demographics
NPI:1134328347
Name:SPRINGFIELD PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:SPRINGFIELD PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOUSEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,OTR/L,MOT
Authorized Official - Phone:937-399-8941
Mailing Address - Street 1:2221 GRUBE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2642
Mailing Address - Country:US
Mailing Address - Phone:937-399-8941
Mailing Address - Fax:937-399-5639
Practice Address - Street 1:2221 GRUBE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2642
Practice Address - Country:US
Practice Address - Phone:937-399-8941
Practice Address - Fax:937-399-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054005Medicaid