Provider Demographics
NPI:1801142989
Name:LONG, THOMAS RYAN (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RYAN
Last Name:LONG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 CREEK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8398
Mailing Address - Country:US
Mailing Address - Phone:513-554-8080
Mailing Address - Fax:513-554-8082
Practice Address - Street 1:4701 CREEK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-8398
Practice Address - Country:US
Practice Address - Phone:513-554-8080
Practice Address - Fax:513-554-8082
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.013792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01150051OtherMEDICARE RAILROAD
OH0074663Medicaid
OH0074663Medicaid
OHH145830Medicare PIN