Provider Demographics
NPI:1558555326
Name:NAPOLEON PHYSICAL THERAPY AND SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:NAPOLEON PHYSICAL THERAPY AND SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:BUDD
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:419-599-0888
Mailing Address - Street 1:1322 WOODLAWN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-1178
Mailing Address - Country:US
Mailing Address - Phone:419-599-0888
Mailing Address - Fax:419-599-0087
Practice Address - Street 1:1322 WOODLAWN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1178
Practice Address - Country:US
Practice Address - Phone:419-599-0888
Practice Address - Fax:419-599-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty