Provider Demographics
NPI:1497797740
Name:EASTGATE PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:EASTGATE PHYSICAL THERAPY LIMITED PARTNERSHIP
Other - Org Name:SUMMIT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:811 EASTGATE SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1547
Mailing Address - Country:US
Mailing Address - Phone:513-753-0500
Mailing Address - Fax:513-753-0555
Practice Address - Street 1:811 EASTGATE SOUTH DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1547
Practice Address - Country:US
Practice Address - Phone:513-753-0500
Practice Address - Fax:513-753-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366705Medicare Oscar/Certification