Provider Demographics
NPI:1609672658
Name:PATRIOT OUTPATIENT THERAPY, LLC
Entity type:Organization
Organization Name:PATRIOT OUTPATIENT THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-883-6532
Mailing Address - Street 1:986 TIBBETTS WICK RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1138
Mailing Address - Country:US
Mailing Address - Phone:330-919-9575
Mailing Address - Fax:
Practice Address - Street 1:5535 IRWIN SIMPSON RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8107
Practice Address - Country:US
Practice Address - Phone:330-919-9575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty