Provider Demographics
NPI:1467442061
Name:UNIVERSITY SPORTS PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:UNIVERSITY SPORTS PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-744-7525
Mailing Address - Street 1:1335 BELMONT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1185
Mailing Address - Country:US
Mailing Address - Phone:330-744-7525
Mailing Address - Fax:330-744-0089
Practice Address - Street 1:1335 BELMONT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1185
Practice Address - Country:US
Practice Address - Phone:330-744-7525
Practice Address - Fax:330-744-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2013-04-15
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
OH0170452Medicaid
OH366645Medicare PIN