Provider Demographics
NPI:1558575209
Name:FERRELL-WHITED PHYSICAL THERAPY SERVICES,INC
Entity Type:Organization
Organization Name:FERRELL-WHITED PHYSICAL THERAPY SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-722-3781
Mailing Address - Street 1:700 EAST WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2136
Mailing Address - Country:US
Mailing Address - Phone:330-722-3781
Mailing Address - Fax:330-725-6294
Practice Address - Street 1:700 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2126
Practice Address - Country:US
Practice Address - Phone:330-722-3781
Practice Address - Fax:330-725-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0952223Medicaid
OH0952223Medicaid