Provider Demographics
NPI:1144457342
Name:GALLIA-JACKSON-VINTON JVSD
Entity type:Organization
Organization Name:GALLIA-JACKSON-VINTON JVSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:D.
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-245-5334
Mailing Address - Street 1:351 BUKEYE HILLS RD.
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:OH
Mailing Address - Zip Code:45674-0157
Mailing Address - Country:US
Mailing Address - Phone:740-245-5334
Mailing Address - Fax:740-245-9465
Practice Address - Street 1:351 BUKEYE HILLS RD.
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:OH
Practice Address - Zip Code:45674-0157
Practice Address - Country:US
Practice Address - Phone:740-245-5334
Practice Address - Fax:740-245-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty