Provider Demographics
NPI:1962613687
Name:SPECIALIZED THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:SPECIALIZED THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:419-228-7871
Mailing Address - Street 1:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:KALIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45853-0079
Mailing Address - Country:US
Mailing Address - Phone:419-228-7871
Mailing Address - Fax:419-228-7872
Practice Address - Street 1:2758 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2120
Practice Address - Country:US
Practice Address - Phone:419-228-7871
Practice Address - Fax:419-228-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT7638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP9375091Medicare PIN