1003190067 NPI number — MR. MICHAEL STEVEN WAHOFF PT

Table of content: (NPI 1801954136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003190067 NPI number — MR. MICHAEL STEVEN WAHOFF PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAHOFF
Provider First Name:
MICHAEL
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003190067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
153 E 13TH ST STE 1300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16503-1035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-452-7781
Provider Business Mailing Address Fax Number:
814-452-7005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4950 BUFFALO RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16510-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-899-7000
Provider Business Practice Location Address Fax Number:
814-898-2198
Provider Enumeration Date:
10/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT028083 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 8503 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)