Provider Demographics
NPI:1497055305
Name:ULTRACARE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ULTRACARE PHYSICAL THERAPY LLC
Other - Org Name:HOME HEALTH OF FREMONT, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AJAYAGHOSH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:419-578-7360
Mailing Address - Street 1:1245 SCHREIER RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1443
Mailing Address - Country:US
Mailing Address - Phone:419-578-7360
Mailing Address - Fax:419-578-7361
Practice Address - Street 1:1245 SCHREIER RD STE A
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1443
Practice Address - Country:US
Practice Address - Phone:419-578-7360
Practice Address - Fax:419-578-7361
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ULTRACARE PHYSICAL THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-25
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0059807Medicaid
OH368387OtherMEDICARE ID