Provider Demographics
NPI:1942824107
Name:EGNOR, MICHAEL G (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:EGNOR
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 PARAGON RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4050
Mailing Address - Country:US
Mailing Address - Phone:937-291-3780
Mailing Address - Fax:937-291-3789
Practice Address - Street 1:7750 PARAGON RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4050
Practice Address - Country:US
Practice Address - Phone:937-291-3780
Practice Address - Fax:937-291-3789
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA001637225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant