Provider Demographics
NPI:1437362191
Name:OZMUN, RICHARD R (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:R
Last Name:OZMUN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W290 GROVER CENTER
Mailing Address - Street 2:OHIO UNIVERSITY THERAPY ASSOCIATES
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2979
Mailing Address - Country:US
Mailing Address - Phone:740-593-0820
Mailing Address - Fax:
Practice Address - Street 1:2 HEALTH CENTER DRIVE
Practice Address - Street 2:SUITE 160 OHIO UNIVERSITY STUDENT HEALTH SERVICE
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-593-4722
Practice Address - Fax:740-593-0921
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 7430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH062447Medicaid
000000163115OtherANTHEM
OH366549Medicare ID - Type UnspecifiedGROUP NUMBER