Provider Demographics
NPI:1245431972
Name:HIRSCHFELD, MICHAEL L (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:HIRSCHFELD
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 1:702 STURGEON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-1570
Mailing Address - Country:US
Mailing Address - Phone:419-348-6063
Mailing Address - Fax:
Practice Address - Street 1:253 W SIXTH ST
Practice Address - Street 2:
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865
Practice Address - Country:US
Practice Address - Phone:419-501-2165
Practice Address - Fax:419-501-2166
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT010452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000376025OtherBLUE CROSS BLUE SHIELD
OH1570754OtherFIRST HEALTH/COVENTRY
OH232804807OtherREHAB PROVIDER NETWORK
OH2781431Medicaid
OH$$$$$$$$$00OtherBWC
OH$$$$$$$$$001OtherMEDICAL MUTUAL
OH1570754OtherFIRST HEALTH/COVENTRY