Provider Demographics
NPI:1205206240
Name:ANGELINE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ANGELINE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANGELINE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:513-575-7878
Mailing Address - Street 1:5914 WOLFPEN PLEASANT HILL RD STE D
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-3078
Mailing Address - Country:US
Mailing Address - Phone:575-248-1700
Mailing Address - Fax:
Practice Address - Street 1:5914 WOLFPEN PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-3079
Practice Address - Country:US
Practice Address - Phone:513-575-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty