Provider Demographics
NPI:1740560424
Name:NBJ OUTPATIENT THERAPY LLC
Entity Type:Organization
Organization Name:NBJ OUTPATIENT THERAPY LLC
Other - Org Name:BLUE SKY THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALFHILL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-702-0110
Mailing Address - Street 1:510 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1454
Mailing Address - Country:US
Mailing Address - Phone:330-702-0110
Mailing Address - Fax:330-702-0510
Practice Address - Street 1:498 LISBON RD
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:PA
Practice Address - Zip Code:16115-3309
Practice Address - Country:US
Practice Address - Phone:724-495-6139
Practice Address - Fax:724-643-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA230179Medicare PIN