Provider Demographics
NPI:1679653141
Name:NARDI, MICHAEL R (DSCPT,MED,RKT,CMPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:NARDI
Suffix:
Gender:M
Credentials:DSCPT,MED,RKT,CMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 AUTUMN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-8219
Mailing Address - Country:US
Mailing Address - Phone:419-624-1636
Mailing Address - Fax:
Practice Address - Street 1:1325 HULL RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-6062
Practice Address - Country:US
Practice Address - Phone:419-626-4162
Practice Address - Fax:419-626-2071
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT06205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0954847Medicaid
OH0954847Medicaid