Provider Demographics
NPI:1679825582
Name:TRIFECTA COMP, INC.
Entity Type:Organization
Organization Name:TRIFECTA COMP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:740-624-5701
Mailing Address - Street 1:403 SAND STREET
Mailing Address - Street 2:
Mailing Address - City:CROOKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43731-1230
Mailing Address - Country:US
Mailing Address - Phone:740-624-5701
Mailing Address - Fax:740-366-2407
Practice Address - Street 1:331 GOOSEPOND ROAD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3184
Practice Address - Country:US
Practice Address - Phone:740-366-0005
Practice Address - Fax:740-366-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOHPTA046982251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty