Provider Demographics
NPI:1508941642
Name:FLEMING, MISTY A (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:A
Last Name:FLEMING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:MISTY
Other - Middle Name:A
Other - Last Name:SHAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1580 CHESHIRE RD
Mailing Address - Street 2:APT 3A
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-5605
Mailing Address - Country:US
Mailing Address - Phone:937-335-3195
Mailing Address - Fax:
Practice Address - Street 1:1201 EXPERIMENT FARM RD
Practice Address - Street 2:SUITE F
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2063
Practice Address - Country:US
Practice Address - Phone:937-332-9800
Practice Address - Fax:937-332-9899
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 011593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000301761OtherANTHEM
OH0108341Medicaid
OH38261719350OtherWORKERS COMP
OH366640Medicare ID - Type Unspecified