Provider Demographics
NPI:1568654549
Name:MID OHIO MEDICAL MASSAGE @ REHABILITATION
Entity Type:Organization
Organization Name:MID OHIO MEDICAL MASSAGE @ REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PATTON-COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:740-397-1447
Mailing Address - Street 1:777 BROOKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-9538
Mailing Address - Country:US
Mailing Address - Phone:740-397-1447
Mailing Address - Fax:740-397-1447
Practice Address - Street 1:11337 UPPER GILCHRIST RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-8923
Practice Address - Country:US
Practice Address - Phone:740-393-2348
Practice Address - Fax:740-393-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy