Provider Demographics
NPI:1972215978
Name:LIGHT TOUCH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LIGHT TOUCH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CMA, BMCP
Authorized Official - Phone:513-792-2300
Mailing Address - Street 1:PO BOX 42302
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-0302
Mailing Address - Country:US
Mailing Address - Phone:513-792-2300
Mailing Address - Fax:513-792-2300
Practice Address - Street 1:11305 REED HARTMAN HWY
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-2485
Practice Address - Country:US
Practice Address - Phone:513-792-2300
Practice Address - Fax:513-792-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0739221Medicaid