Provider Demographics
NPI:1184682932
Name:BELLEFONTAINE PHYSICAL THERAPY LTD
Entity Type:Organization
Organization Name:BELLEFONTAINE PHYSICAL THERAPY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEVUS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:937-592-1625
Mailing Address - Street 1:711 RUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311
Mailing Address - Country:US
Mailing Address - Phone:937-592-1625
Mailing Address - Fax:937-592-3489
Practice Address - Street 1:711 RUSH AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311
Practice Address - Country:US
Practice Address - Phone:937-592-1625
Practice Address - Fax:937-592-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
BE9312591Medicare ID - Type Unspecified