Provider Demographics
NPI:1356721815
Name:CELLER O'TOOLE, PT. INC.
Entity type:Organization
Organization Name:CELLER O'TOOLE, PT. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELLER
Authorized Official - Middle Name:YING
Authorized Official - Last Name:O'TOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:614-578-8706
Mailing Address - Street 1:140 HOLDER RD NE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43105-9710
Mailing Address - Country:US
Mailing Address - Phone:614-578-8706
Mailing Address - Fax:
Practice Address - Street 1:2862 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3709
Practice Address - Country:US
Practice Address - Phone:614-578-8706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-31
Last Update Date:2015-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2892261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2699147Medicaid
4194771Medicare PIN