Provider Demographics
NPI:1407842347
Name:UNITED STATES AIR FORCE
Entity Type:Organization
Organization Name:UNITED STATES AIR FORCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:FRANKART
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:937-257-8753
Mailing Address - Street 1:3878 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-9719
Mailing Address - Country:US
Mailing Address - Phone:937-902-6686
Mailing Address - Fax:
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5546
Practice Address - Country:US
Practice Address - Phone:937-257-8753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 75632865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1336335439Medicare NSC