Provider Demographics
NPI:1740260165
Name:SPRAGUE, HELEN HOLUB (PT)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:HOLUB
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 GRANGE HILL PL
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1794
Mailing Address - Country:US
Mailing Address - Phone:614-764-8021
Mailing Address - Fax:614-764-8021
Practice Address - Street 1:3122 GRANGE HILL PL
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1794
Practice Address - Country:US
Practice Address - Phone:614-764-8021
Practice Address - Fax:614-764-8021
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0607311Medicare ID - Type UnspecifiedPHYSICAL THERAPIST