Provider Demographics
NPI:1790288983
Name:IMPACT PERFORMANCE THERAPY
Entity Type:Organization
Organization Name:IMPACT PERFORMANCE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARINA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MS, CSCS
Authorized Official - Phone:717-599-0131
Mailing Address - Street 1:1209 HILL RD N
Mailing Address - Street 2:PMB 321
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147
Mailing Address - Country:US
Mailing Address - Phone:717-599-0131
Mailing Address - Fax:
Practice Address - Street 1:21 W COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1055
Practice Address - Country:US
Practice Address - Phone:717-599-0131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016748261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy