Provider Demographics
NPI:1396810917
Name:WEBSTER, JOHN THOMAS (LPT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 S BYRNE RD
Mailing Address - Street 2:SUITE DD
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3464
Mailing Address - Country:US
Mailing Address - Phone:419-385-7755
Mailing Address - Fax:419-385-8007
Practice Address - Street 1:1614 S BYRNE RD
Practice Address - Street 2:SUITE DD
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3464
Practice Address - Country:US
Practice Address - Phone:419-385-7755
Practice Address - Fax:419-385-8007
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0755017Medicaid
OH341601561-01OtherWORKERS COMP. PROVIDER NO
OH341601561-00OtherWORKERS COMP. PROVIDER NO
OH000000134925OtherANTHEM BC & BS PIN
OH341601561-01OtherWORKERS COMP. PROVIDER NO
OH0648711Medicare ID - Type Unspecified