Provider Demographics
NPI:1811976228
Name:STAR PT INC
Entity type:Organization
Organization Name:STAR PT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/MPT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOLLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:419-443-1429
Mailing Address - Street 1:3101 W US RT 224
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883
Mailing Address - Country:US
Mailing Address - Phone:419-443-1429
Mailing Address - Fax:419-443-1691
Practice Address - Street 1:3101 W US RT 224
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883
Practice Address - Country:US
Practice Address - Phone:419-443-1429
Practice Address - Fax:419-443-1691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2527699Medicaid
OH1442035OtherBWC
OH1442035OtherBWC
OH5217870001Medicare NSC