Provider Demographics
NPI:1285318063
Name:BOLLIN, DAMON
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:BOLLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 REYNOLDS AVENUE
Mailing Address - Street 2:APARTMENT 101
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-4392
Mailing Address - Country:US
Mailing Address - Phone:440-759-1319
Mailing Address - Fax:
Practice Address - Street 1:459 REYNOLDS AVE APT 101
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-4392
Practice Address - Country:US
Practice Address - Phone:440-759-1319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist