Provider Demographics
NPI:1932180411
Name:CARMICHAEL, EDWARD SCOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:SCOTT
Last Name:CARMICHAEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 W SYLVANIA AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4501
Mailing Address - Country:US
Mailing Address - Phone:419-517-7538
Mailing Address - Fax:419-517-7539
Practice Address - Street 1:7640 SYLVANIA AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9729
Practice Address - Country:US
Practice Address - Phone:419-517-7538
Practice Address - Fax:419-517-7539
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-04723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH252944OtherANTHEM BCBS
OH2326898Medicaid
OH343917OtherANTHEM BCBS
OH252937OtherANTHEM BCBS
OH252944OtherANTHEM BCBS
OH252937OtherANTHEM BCBS