Provider Demographics
NPI:1871632182
Name:ENLIGHTENED THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ENLIGHTENED THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-278-1779
Mailing Address - Street 1:77 E WOODBURY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2855
Mailing Address - Country:US
Mailing Address - Phone:937-278-1779
Mailing Address - Fax:937-278-4197
Practice Address - Street 1:2510 COMMONS BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3809
Practice Address - Country:US
Practice Address - Phone:937-429-8620
Practice Address - Fax:937-429-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty