Provider Demographics
NPI:1982894523
Name:FUNCTIONAL PHYSICAL THERAPY OF OHIO INC
Entity Type:Organization
Organization Name:FUNCTIONAL PHYSICAL THERAPY OF OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKANT
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-673-6980
Mailing Address - Street 1:5225 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1916
Mailing Address - Country:US
Mailing Address - Phone:248-673-2762
Mailing Address - Fax:248-673-3347
Practice Address - Street 1:129 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1628
Practice Address - Country:US
Practice Address - Phone:440-774-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFU9343381Medicare PIN