Podium LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT016306 Issued in OH

Legal business name

PODIUM LLC

Practice address

20 E Madison Ave
Shelby, OH 44875-1614

Phone

(419) 982-0062

NPI assigned

May 19, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jared Bonecutter, PT, DPT

Title

President

Phone

(419) 982-0062

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463616000000",
    "number": "1740637826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 E MADISON AVE",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448751614",
            "telephone_number": "419-982-0062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 E MADISON AVE",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448751614",
            "telephone_number": "419-982-0062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PODIUM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-19",
        "last_updated": "2016-05-19",
        "status": "A",
        "authorized_official_last_name": "BONECUTTER",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-982-0062",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OH",
            "license": "PT016306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Perkins
• Syhara Perry
• Sadie Petty
• Tyler Phenneger
• Caitlin Phillips, LISW
• Gerald Polk, CDCA
• Matthew J Porter, CDCA
• Dwayne Price, CDCA
• Alexia Prichard
• Dustin James Pridemore, CDCA

• Physical Therapy Clinic/Center in Shelby, OH
• Providers in Shelby, OH by specialty
• Physical Therapy Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.