Provider Demographics
NPI:1922291715
Name:EPPICH, WILLIAM L (DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:EPPICH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-4679
Mailing Address - Country:US
Mailing Address - Phone:440-357-9704
Mailing Address - Fax:
Practice Address - Street 1:9002 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6302
Practice Address - Country:US
Practice Address - Phone:440-266-1901
Practice Address - Fax:440-266-1902
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2826606Medicaid
OH9304631OtherMEDICARE GROUP ID
OH2826606Medicaid