Provider Demographics
NPI:1265521025
Name:PHYSICAL THERAPY AND OCCUPATIONAL REHABILITATION INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY AND OCCUPATIONAL REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-386-5252
Mailing Address - Street 1:15765 STATE ROUTE 170
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9070
Mailing Address - Country:US
Mailing Address - Phone:330-386-5252
Mailing Address - Fax:330-386-3555
Practice Address - Street 1:15765 STATE ROUTE 170
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9070
Practice Address - Country:US
Practice Address - Phone:330-386-5252
Practice Address - Fax:330-386-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08856261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2516290Medicaid
OH2516290Medicaid
OH9346042Medicare PIN