Provider Demographics
NPI:1215948302
Name:ARCHBOLD PHYSICAL THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:ARCHBOLD PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIEDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT MA
Authorized Official - Phone:419-446-9144
Mailing Address - Street 1:815 EAST LUTZ ROAD
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502
Mailing Address - Country:US
Mailing Address - Phone:419-446-9144
Mailing Address - Fax:419-466-9146
Practice Address - Street 1:815 EAST LUTZ ROAD
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502
Practice Address - Country:US
Practice Address - Phone:419-446-9144
Practice Address - Fax:419-466-9146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0123397Medicaid
OHAR9270811Medicare PIN