Provider Demographics
NPI:1184633703
Name:BARILE, MICHAEL FELIX (DC,PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FELIX
Last Name:BARILE
Suffix:
Gender:M
Credentials:DC,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 350034
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43635-0034
Mailing Address - Country:US
Mailing Address - Phone:260-420-4400
Mailing Address - Fax:260-420-4448
Practice Address - Street 1:3030 LAKE AVE
Practice Address - Street 2:26
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5428
Practice Address - Country:US
Practice Address - Phone:260-420-4400
Practice Address - Fax:260-420-4448
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001260A111N00000X
IN05005672A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200185830Medicaid
INCG1609Medicare PIN
IN200185830Medicaid