Provider Demographics
NPI:1770094856
Name:HOMETOWN THERAPY GROUP LLC
Entity type:Organization
Organization Name:HOMETOWN THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:419-615-9730
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:KALIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45853-0228
Mailing Address - Country:US
Mailing Address - Phone:567-221-1021
Mailing Address - Fax:
Practice Address - Street 1:1200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-2616
Practice Address - Country:US
Practice Address - Phone:567-221-1021
Practice Address - Fax:567-221-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT008532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty