Provider Demographics
NPI:1174795397
Name:MOHICAN THERAPY GROUP
Entity type:Organization
Organization Name:MOHICAN THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-392-8811
Mailing Address - Street 1:112 HARCOURT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3946
Mailing Address - Country:US
Mailing Address - Phone:740-392-8811
Mailing Address - Fax:
Practice Address - Street 1:17809 STATE ROUTE 31
Practice Address - Street 2:MILL VALLEY PLAZA UNIT 9
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9609
Practice Address - Country:US
Practice Address - Phone:937-738-7818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty