Provider Demographics
NPI:1962634683
Name:MID-OHIO IN HOME PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MID-OHIO IN HOME PHYSICAL THERAPY, LLC
Other - Org Name:MID- OHIO PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KEIPER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:419-948-0144
Mailing Address - Street 1:206 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1115
Mailing Address - Country:US
Mailing Address - Phone:419-948-0144
Mailing Address - Fax:419-946-6609
Practice Address - Street 1:206 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1115
Practice Address - Country:US
Practice Address - Phone:419-948-0144
Practice Address - Fax:419-946-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy