Provider Demographics
NPI:1679381248
Name:3 PHASE ENDURANCE TRAINING LLC
Entity type:Organization
Organization Name:3 PHASE ENDURANCE TRAINING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDLACK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:419-438-5026
Mailing Address - Street 1:11154 ROAD 230
Mailing Address - Street 2:
Mailing Address - City:CECIL
Mailing Address - State:OH
Mailing Address - Zip Code:45821-9309
Mailing Address - Country:US
Mailing Address - Phone:419-438-5026
Mailing Address - Fax:
Practice Address - Street 1:11154 ROAD 230
Practice Address - Street 2:
Practice Address - City:CECIL
Practice Address - State:OH
Practice Address - Zip Code:45821-9309
Practice Address - Country:US
Practice Address - Phone:419-438-5026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty