Provider Demographics
NPI:1275559601
Name:ULTRACARE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ULTRACARE PHYSICAL THERAPY LLC
Other - Org Name:ULTRACARE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJAYAGHOSH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:419-578-7360
Mailing Address - Street 1:14850 STONEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-9500
Mailing Address - Country:US
Mailing Address - Phone:419-344-1425
Mailing Address - Fax:419-578-7361
Practice Address - Street 1:1245 SCHREIER RD
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1443
Practice Address - Country:US
Practice Address - Phone:419-578-7360
Practice Address - Fax:419-578-7361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0007954Medicaid