Provider Demographics
NPI:1528041274
Name:MARYSVILLE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MARYSVILLE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-644-3311
Mailing Address - Street 1:211 STOCKSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-5507
Mailing Address - Country:US
Mailing Address - Phone:937-644-3311
Mailing Address - Fax:937-644-0373
Practice Address - Street 1:211 STOCKSDALE DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-5507
Practice Address - Country:US
Practice Address - Phone:937-644-3311
Practice Address - Fax:937-644-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 004515225100000X, 2251X0800X
OH96110004502251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000161895OtherANTHEM GROUP NUMBER
OH2614531Medicaid
OH685840OtherUNITED HEALTHCARE GROUP
OH15668OtherNATIONWIDE INSURANCE NUMB
OH23-2804807OtherREHAB PROVIDER NETWORK NU
OH=========OtherMEDICAL MUTUAL GROUP NUMB
=========OtherPHCS NETWORK
OH23-2804807OtherREHAB PROVIDER NETWORK NU
=========-00OtherBUREAU OF WORKERS COMPENS
OH2614531Medicaid