Provider Demographics
NPI:1598746497
Name:DISTEL, ALAN R (PT)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:R
Last Name:DISTEL
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:P O BOX 239
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45839-1345
Mailing Address - Country:US
Mailing Address - Phone:419-422-5526
Mailing Address - Fax:
Practice Address - Street 1:1725 WESTERN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1345
Practice Address - Country:US
Practice Address - Phone:419-422-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2269905Medicaid
OH250933OtherANTHEM BCBS
OH252932OtherANTHEM BCBS
OH2269905Medicaid
OH4041574Medicare ID - Type Unspecified
OH4041571Medicare ID - Type Unspecified