Provider Demographics
NPI:1720214745
Name:WINTERSVILLE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:WINTERSVILLE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THADDAUES
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHRICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-264-6235
Mailing Address - Street 1:1562 CADIZ RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-7630
Mailing Address - Country:US
Mailing Address - Phone:740-264-1417
Mailing Address - Fax:
Practice Address - Street 1:1562 CADIZ ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953
Practice Address - Country:US
Practice Address - Phone:740-264-1417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty