1144506098 NPI number — MIKE FURDA, LLC

Table of content: (NPI 1144506098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144506098 NPI number — MIKE FURDA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIKE FURDA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELITE PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1144506098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTERSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43953-3734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-264-0661
Provider Business Mailing Address Fax Number:
740-264-4376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
426 CAROLINA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26034-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-266-6855
Provider Business Practice Location Address Fax Number:
740-275-4182
Provider Enumeration Date:
10/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
FURDA
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
740-266-6855

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT000804 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000804 . This is a "PT LICENSE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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