Provider Demographics
NPI:1790901726
Name:TUSCARAWAS VALLEY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TUSCARAWAS VALLEY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-364-2233
Mailing Address - Street 1:335 OXFORD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1970
Mailing Address - Country:US
Mailing Address - Phone:330-364-2233
Mailing Address - Fax:330-364-7744
Practice Address - Street 1:335 OXFORD STREET
Practice Address - Street 2:SUITE B
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1970
Practice Address - Country:US
Practice Address - Phone:330-364-2233
Practice Address - Fax:330-364-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-04-30
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
OH2188958Medicaid
OH000000167601OtherANTHEM BC & BS GROUP NUMB
OH2188958Medicaid
OHTU9301431Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER