Provider Demographics
NPI:1851600878
Name:OHIO STATE
Entity Type:Organization
Organization Name:OHIO STATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:614-293-0043
Mailing Address - Street 1:4019 W DUBLIN GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1436
Mailing Address - Country:US
Mailing Address - Phone:614-293-0045
Mailing Address - Fax:614-293-6962
Practice Address - Street 1:4019 W DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1436
Practice Address - Country:US
Practice Address - Phone:614-293-0045
Practice Address - Fax:614-293-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9978284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital