Provider Demographics
NPI:1639293335
Name:PHYSICAL THERAPY SERVICES OF MT
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF MT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BURGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-393-1144
Mailing Address - Street 1:PO BOX 3644
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907
Mailing Address - Country:US
Mailing Address - Phone:740-393-1144
Mailing Address - Fax:740-393-1152
Practice Address - Street 1:1220 YAUGER RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-393-1144
Practice Address - Fax:740-393-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PH9348391Medicare ID - Type Unspecified