Provider Demographics
NPI:1326149295
Name:EASTGATE PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:EASTGATE PHYSICAL THERAPY LIMITED PARTNERSHIP
Other - Org Name:SUMMIT PHYSICAL THERAPY (NEW RICHMOND)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP,AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:1300 W SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2447
Mailing Address - Country:US
Mailing Address - Phone:713-297-7000
Mailing Address - Fax:713-297-7090
Practice Address - Street 1:1041 OLD US ROUTE 52
Practice Address - Street 2:SUITE F
Practice Address - City:NEW RICHMOND
Practice Address - State:OH
Practice Address - Zip Code:45157
Practice Address - Country:US
Practice Address - Phone:513-553-1921
Practice Address - Fax:513-553-1967
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTGATE PHYSICAL THERAPY LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366705Medicare Oscar/Certification