Provider Demographics
NPI:1336341973
Name:ATHLETIC ADVANTAGE, INC
Entity Type:Organization
Organization Name:ATHLETIC ADVANTAGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:READ
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:740-549-7041
Mailing Address - Street 1:8849 WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7107
Mailing Address - Country:US
Mailing Address - Phone:740-549-7041
Mailing Address - Fax:
Practice Address - Street 1:8849 WHITNEY DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-7107
Practice Address - Country:US
Practice Address - Phone:740-549-7041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9348541Medicare ID - Type Unspecified