Provider Demographics
NPI:1124786009
Name:VINE PERFORMANCE THERAPY LLC
Entity type:Organization
Organization Name:VINE PERFORMANCE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TEKNIPP
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:740-990-6311
Mailing Address - Street 1:220 SEATRAIN DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-3418
Mailing Address - Country:US
Mailing Address - Phone:740-990-6311
Mailing Address - Fax:
Practice Address - Street 1:400 LAZELLE RD STE 10
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-2077
Practice Address - Country:US
Practice Address - Phone:740-936-7774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy