Provider Demographics
NPI:1477545523
Name:UNFERDORFER, ANNETTE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:UNFERDORFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2964 NW LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-9441
Mailing Address - Country:US
Mailing Address - Phone:330-828-0601
Mailing Address - Fax:
Practice Address - Street 1:335 OXFORD ST
Practice Address - Street 2:SUITE B
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1970
Practice Address - Country:US
Practice Address - Phone:330-364-2233
Practice Address - Fax:330-364-7744
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-03684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHUN4151001Medicare ID - Type Unspecified