Provider Demographics
NPI:1861458549
Name:JAWORSKI PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:JAWORSKI PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:JAWORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:440-366-5993
Mailing Address - Street 1:137 WINCKLES STREET
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035
Mailing Address - Country:US
Mailing Address - Phone:440-366-5993
Mailing Address - Fax:440-366-5313
Practice Address - Street 1:137 WINCKLES STREET
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-366-5993
Practice Address - Fax:440-366-5313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0654140OtherAETNA
OH2167462Medicaid
OH000000217335OtherANTHEM BLUE CROSS
OH000000217337OtherANTHEM BLUE CROSS
OH000000166082OtherANTHEM BLUE CROSS
OH2167462Medicaid
OH=========OtherMEDICAL MUTUAL
OH2167462Medicaid