Provider Demographics
NPI:1629006556
Name:DISTEL, JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
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 1:8437 LAKEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-8870
Mailing Address - Country:US
Mailing Address - Phone:419-422-5526
Mailing Address - Fax:
Practice Address - Street 1:1725 WESTERN AVE STE B
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1390
Practice Address - Country:US
Practice Address - Phone:419-422-5526
Practice Address - Fax:419-422-5562
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-04742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04764OtherPARAMOUNT
OHDI4057732OtherADMINISTAR FEDERAL
OHP00178552OtherRR MEDICARE
OH000000355382OtherANTHEM
OH2322249Medicaid
OH28862522000OtherBUREAU OF WORKERS COMP
OH04764OtherPARAMOUNT