Provider Demographics
NPI:1457446031
Name:SPECTRUM ATHLETICS
Entity Type:Organization
Organization Name:SPECTRUM ATHLETICS
Other - Org Name:SEE THE TRAINER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROBST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-871-7551
Mailing Address - Street 1:837 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214
Mailing Address - Country:US
Mailing Address - Phone:614-326-1981
Mailing Address - Fax:614-326-1983
Practice Address - Street 1:837 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:614-326-1981
Practice Address - Fax:614-326-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH25282832332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4346130001Medicare ID - Type Unspecified