Provider Demographics
NPI:1912117458
Name:PHYSIOMAX REHAB,LLC
Entity Type:Organization
Organization Name:PHYSIOMAX REHAB,LLC
Other - Org Name:CELINA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZEFFERRELLI
Authorized Official - Middle Name:QUIJANO
Authorized Official - Last Name:MELENDREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:419-302-0744
Mailing Address - Street 1:326 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-2245
Mailing Address - Country:US
Mailing Address - Phone:419-586-2100
Mailing Address - Fax:419-586-2117
Practice Address - Street 1:326 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2245
Practice Address - Country:US
Practice Address - Phone:419-586-2100
Practice Address - Fax:419-586-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1700359261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
9371351Medicare PIN