Provider Demographics
NPI:1578007522
Name:TELETHERAPY DIRECT, LLC
Entity Type:Organization
Organization Name:TELETHERAPY DIRECT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS, OCS
Authorized Official - Phone:888-648-4372
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:44 NORTH BROAD STREET
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-0272
Mailing Address - Country:US
Mailing Address - Phone:888-648-4372
Mailing Address - Fax:888-648-4372
Practice Address - Street 1:261 DARTMOUTH DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1215
Practice Address - Country:US
Practice Address - Phone:888-648-4372
Practice Address - Fax:888-648-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-10
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty