Provider Demographics
NPI:1396861464
Name:FURDA, MICHAEL E (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:FURDA
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 1:110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3734
Mailing Address - Country:US
Mailing Address - Phone:740-266-6855
Mailing Address - Fax:
Practice Address - Street 1:115 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3733
Practice Address - Country:US
Practice Address - Phone:740-266-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT004752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH699738OtherANTHEM BC/BS
203267955OtherTAX ID
OH536082OtherINDIVIDUAL BCBS
OH536080OtherGROUP BCBS NUMBER
OH2650108Medicaid
732344OtherHEALTH ASSURANCE
OH536082OtherINDIVIDUAL BCBS
203267955OtherTAX ID
WVA800Medicare PIN
OH536080OtherGROUP BCBS NUMBER
732344OtherHEALTH ASSURANCE
OHGA9368841Medicare PIN
OHFU4122772Medicare ID - Type Unspecified
OH2650108Medicaid
OHH016200Medicare PIN