Provider Demographics
NPI:1639142029
Name:CHOICE PHYSICAL THERAPY OF OHIO LLC
Entity Type:Organization
Organization Name:CHOICE PHYSICAL THERAPY OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAIR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC, MED
Authorized Official - Phone:513-792-0777
Mailing Address - Street 1:9419 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6811
Mailing Address - Country:US
Mailing Address - Phone:513-792-0777
Mailing Address - Fax:513-792-0061
Practice Address - Street 1:9419 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-6811
Practice Address - Country:US
Practice Address - Phone:513-792-0777
Practice Address - Fax:513-792-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH300563892002OtherMEDICAL MUTUAL W
OH9603OtherRR MEDICARE GROUP
OH270828495001OtherMEDICAL MUTUAL G
OH650023013OtherRR MEDICARE PTAN
OH000000178624OtherANTHEM PIN
OHCJ9603OtherRR MEDICARE GROUP
OH269528041004OtherMEDICAL MUTUAL B
OHP00611846OtherRR MEDICARE PTAN (3)
OHP00434380OtherRR MEDICARE PTAN (2)
OH9603OtherRR MEDICARE GROUP
OHP00611846OtherRR MEDICARE PTAN (3)
OH000000178624OtherANTHEM PIN