Provider Demographics
NPI:1275827149
Name:INTEGRATED ORTHOPAEDIC & SPORTS REHABILITATION,LTD
Entity Type:Organization
Organization Name:INTEGRATED ORTHOPAEDIC & SPORTS REHABILITATION,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SNAVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-447-0760
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-7089
Mailing Address - Country:US
Mailing Address - Phone:419-447-0760
Mailing Address - Fax:419-447-0765
Practice Address - Street 1:47 MIAMI ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2226
Practice Address - Country:US
Practice Address - Phone:419-447-0760
Practice Address - Fax:419-447-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT3118261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy