Provider Demographics
NPI:1750782074
Name:IN HOME PEDIATRIC PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:IN HOME PEDIATRIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ROSE DUES, PT
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:502-510-5297
Mailing Address - Street 1:2468 DYSART RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4445
Mailing Address - Country:US
Mailing Address - Phone:502-510-5297
Mailing Address - Fax:801-681-0724
Practice Address - Street 1:2468 DYSART RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4445
Practice Address - Country:US
Practice Address - Phone:502-510-5297
Practice Address - Fax:801-681-0724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0124832251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH3206763OtherSTATE OF OHIO DEPARTMENT OF EDUCATION PROFESSIONAL PUPIL LICENSE
OH42253OtherAPTA BOARD CERTIFIED CLINICAL SPECIALIST PEDIATRICS
OH012483OtherOHIO PHYSICAL THERAPY LICENSE