Provider Demographics
NPI:1821246745
Name:OSBORN, NANCY G (PTA)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:G
Last Name:OSBORN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11355 HEMPLE RD
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45325-9215
Mailing Address - Country:US
Mailing Address - Phone:937-696-3078
Mailing Address - Fax:937-696-3078
Practice Address - Street 1:425 LAURICELLA CT.
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322
Practice Address - Country:US
Practice Address - Phone:513-677-6460
Practice Address - Fax:513-683-1500
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04734225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant