Provider Demographics
NPI:1891967493
Name:FERRELL-WHITED PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FERRELL-WHITED PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAYLINEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-722-3781
Mailing Address - Street 1:740 EAST WASHINGTON AVENUE
Mailing Address - Street 2:SUITE E4
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2136
Mailing Address - Country:US
Mailing Address - Phone:330-722-3781
Mailing Address - Fax:330-725-6294
Practice Address - Street 1:740 EAST WASHINGTON AVENUE
Practice Address - Street 2:SUITE E4
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2136
Practice Address - Country:US
Practice Address - Phone:330-722-3781
Practice Address - Fax:330-725-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2795319332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0952223Medicaid
OH9318491Medicare PIN