Provider Demographics
NPI:1558329102
Name:VAHILA, MICHAEL JEROME (MT RAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JEROME
Last Name:VAHILA
Suffix:
Gender:M
Credentials:MT RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 18TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2105
Mailing Address - Country:US
Mailing Address - Phone:330-477-0777
Mailing Address - Fax:330-477-0777
Practice Address - Street 1:4643 18TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2105
Practice Address - Country:US
Practice Address - Phone:330-477-0777
Practice Address - Fax:330-477-0777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106171100000X
OH6934225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist