Provider Demographics
NPI:1619919248
Name:PHYSICAL THERAPY & SPORTS REHAB, INC.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY & SPORTS REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIFFLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-609-8600
Mailing Address - Street 1:8133 E MARKET ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2256
Mailing Address - Country:US
Mailing Address - Phone:330-609-8600
Mailing Address - Fax:330-609-5237
Practice Address - Street 1:8133 E MARKET ST STE 1
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2256
Practice Address - Country:US
Practice Address - Phone:330-609-8600
Practice Address - Fax:330-609-5237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0260668Medicaid
OH0260668Medicaid