Provider Demographics
NPI:1801864731
Name:MCBRIDE, PETER ROBERT (PT)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ROBERT
Last Name:MCBRIDE
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6441 MARATHON EDENTON RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:OH
Mailing Address - Zip Code:45122-9500
Mailing Address - Country:US
Mailing Address - Phone:513-625-1694
Mailing Address - Fax:
Practice Address - Street 1:3187 WESTERN ROW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8045
Practice Address - Country:US
Practice Address - Phone:513-459-8599
Practice Address - Fax:513-459-8746
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT008304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT008304OtherSTATE OF OHIO