Provider Demographics
NPI:1033159918
Name:PETERS, MICHAEL E (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:PETERS
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 1:1675 LANCE POINTE RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1603
Mailing Address - Country:US
Mailing Address - Phone:419-891-9800
Mailing Address - Fax:419-891-0989
Practice Address - Street 1:1675 LANCE POINTE RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1603
Practice Address - Country:US
Practice Address - Phone:419-891-9800
Practice Address - Fax:419-891-0989
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2422131Medicaid
OH2422131Medicaid