Provider Demographics
NPI:1427256353
Name:LONG, ANTHONY WILLIAM (PT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:WILLIAM
Last Name:LONG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:1590 STRINGTOWN RD
Practice Address - Street 2:UNIT 21
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9832
Practice Address - Country:US
Practice Address - Phone:614-594-5341
Practice Address - Fax:614-539-2953
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH319270Medicare PIN