Provider Demographics
NPI:1447203039
Name:TRICOUNTY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TRICOUNTY PHYSICAL THERAPY
Other - Org Name:SPORTS REHABILITATION CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-725-4872
Mailing Address - Street 1:3983B PEARL RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9036
Mailing Address - Country:US
Mailing Address - Phone:330-725-4872
Mailing Address - Fax:330-725-4878
Practice Address - Street 1:3983B PEARL RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9036
Practice Address - Country:US
Practice Address - Phone:330-725-4872
Practice Address - Fax:330-725-4878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRICOUNTY PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2161084Medicaid
OHTR9266032Medicare ID - Type UnspecifiedMEDICARE OH MEDINA GRP