Provider Demographics
NPI:1871783712
Name:HEALY, JOHN P (PTA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:HEALY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9644 OLDE PARK CT
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-8135
Mailing Address - Country:US
Mailing Address - Phone:937-669-4709
Mailing Address - Fax:
Practice Address - Street 1:9644 OLDE PARK CT
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-8135
Practice Address - Country:US
Practice Address - Phone:937-669-4709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06047225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant