Provider Demographics
NPI:1780666933
Name:IRONTON PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:IRONTON PHYSICAL THERAPY INC
Other - Org Name:TRI-STATE REHAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RITCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-324-0540
Mailing Address - Street 1:2700 GREENUP AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1953
Mailing Address - Country:US
Mailing Address - Phone:606-324-0540
Mailing Address - Fax:606-324-0616
Practice Address - Street 1:2700 GREENUP AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1953
Practice Address - Country:US
Practice Address - Phone:606-324-0540
Practice Address - Fax:606-324-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2022-08-24
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
OH2055190Medicaid
OH2632235Medicaid
KY7100155430Medicaid
KYCG5254Medicare PIN
KY8822Medicare PIN
OH2632235Medicaid
OH2055190Medicaid
WVCG9084Medicare PIN
OHIR9295431Medicare PIN
KY7100155430Medicaid