Provider Demographics
NPI:1639635733
Name:ATHENA THERAPY HOLDINGS CO
Entity Type:Organization
Organization Name:ATHENA THERAPY HOLDINGS CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-410-3982
Mailing Address - Street 1:4293 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7707
Mailing Address - Country:US
Mailing Address - Phone:330-410-3982
Mailing Address - Fax:330-451-5700
Practice Address - Street 1:1250 YOUNGSTOWN WARREN RD STE B
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4649
Practice Address - Country:US
Practice Address - Phone:330-989-3893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA THERAPY HOLDINGS CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy