Provider Demographics
NPI:1063534931
Name:BELMONT PHYSICAL THERAPY
Entity type:Organization
Organization Name:BELMONT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MACRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-695-9868
Mailing Address - Street 1:51687 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:ST CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950
Mailing Address - Country:US
Mailing Address - Phone:740-695-9868
Mailing Address - Fax:740-695-3385
Practice Address - Street 1:51687 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:ST CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950
Practice Address - Country:US
Practice Address - Phone:740-695-9868
Practice Address - Fax:740-695-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT02427261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2324247Medicaid
OHBE9319891Medicare ID - Type Unspecified
OH2324247Medicaid