Provider Demographics
NPI:1003859273
Name:SZAKAL, THOMAS J (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:SZAKAL
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 1:5105 SOM CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4203
Mailing Address - Country:US
Mailing Address - Phone:440-953-5792
Mailing Address - Fax:
Practice Address - Street 1:5105 SOM CENTER ROAD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4273
Practice Address - Country:US
Practice Address - Phone:440-953-5792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT04945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2332498Medicaid
OH9304631OtherMEDICARE GROUP ID
OH1003859273OtherKAISER