Provider Demographics
NPI:1467555482
Name:MICHAEL M SUPLER & ASSOCIATES INC
Entity Type:Organization
Organization Name:MICHAEL M SUPLER & ASSOCIATES INC
Other - Org Name:UNIVERSITY SUBURBAN PHYSICAL THERAPY UNIVERSITY SUBURBAN SPORTS MEDICI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MCGRAW
Authorized Official - Last Name:SUPLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:216-291-2277
Mailing Address - Street 1:1611 SOUTH GREEN ROAD
Mailing Address - Street 2:SUITE #036
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4128
Mailing Address - Country:US
Mailing Address - Phone:216-291-2277
Mailing Address - Fax:216-291-5707
Practice Address - Street 1:1611 SOUTH GREEN ROAD
Practice Address - Street 2:SUITE #036
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4128
Practice Address - Country:US
Practice Address - Phone:216-291-2277
Practice Address - Fax:216-291-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCG6162OtherRAILROAD MEDICARE
OH0280379Medicaid
OHCG6162OtherRAILROAD MEDICARE
OH0306230001Medicare NSC