Provider Demographics
NPI:1508068164
Name:SPECTRUM THERAPY,LLC
Entity Type:Organization
Organization Name:SPECTRUM THERAPY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SPECTRUM THERAPY,LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VACCA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:614-388-5877
Mailing Address - Street 1:52 WESTERVILLE SQ
Mailing Address - Street 2:P.M.B. # 201
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2919
Mailing Address - Country:US
Mailing Address - Phone:614-388-5877
Mailing Address - Fax:614-388-5877
Practice Address - Street 1:5020 REED RD
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2581
Practice Address - Country:US
Practice Address - Phone:614-388-5877
Practice Address - Fax:614-388-5877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5072225100000X
OH5840225100000X
OH9081225100000X
OH415225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty