Provider Demographics
NPI:1689619447
Name:PICHKAR, BORIS (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:PICHKAR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 WARRENSVILLE CENTER RD
Mailing Address - Street 2:SUITE 102-D
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5288
Mailing Address - Country:US
Mailing Address - Phone:440-580-0088
Mailing Address - Fax:440-580-0088
Practice Address - Street 1:3570 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 102-D
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5288
Practice Address - Country:US
Practice Address - Phone:440-580-0088
Practice Address - Fax:440-580-0088
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7525225100000X, 2251E1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2430926Medicaid
OHPI4111731Medicare ID - Type Unspecified
OH2430926Medicaid