Provider Demographics
NPI:1518039874
Name:FERRARIO, OMAR H (PT)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:H
Last Name:FERRARIO
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 1:5129 E 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-945-5777
Mailing Address - Fax:219-945-5777
Practice Address - Street 1:5129 E 81ST AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-945-5777
Practice Address - Fax:219-945-5777
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003066A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000282378OtherBCBS
INP00223557Medicare ID - Type UnspecifiedRR MC
IN091110DMedicare ID - Type Unspecified