Provider Demographics
NPI:1205470606
Name:SOLE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SOLE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERYN
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:419-376-6222
Mailing Address - Street 1:1494 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2742
Mailing Address - Country:US
Mailing Address - Phone:419-376-6222
Mailing Address - Fax:
Practice Address - Street 1:1562 KING AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2124
Practice Address - Country:US
Practice Address - Phone:419-376-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy