Provider Demographics
NPI:1821523416
Name:SHORT NORTH PEAK PERFORMANCE & PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SHORT NORTH PEAK PERFORMANCE & PHYSICAL THERAPY
Other - Org Name:SHORT NORTH PEAK PERFORMANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:DR. OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:574-276-5617
Mailing Address - Street 1:1054 HAMLET ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3588
Mailing Address - Country:US
Mailing Address - Phone:574-276-5617
Mailing Address - Fax:
Practice Address - Street 1:1054 HAMLET ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3588
Practice Address - Country:US
Practice Address - Phone:574-276-5617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201700201410261QP2000X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty