Provider Demographics
NPI:1104947464
Name:MCINTYRE, JOHN E (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 E RIVER ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444-1373
Mailing Address - Country:US
Mailing Address - Phone:330-872-7242
Mailing Address - Fax:330-872-7372
Practice Address - Street 1:17 E RIVER ST
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-1373
Practice Address - Country:US
Practice Address - Phone:330-872-7242
Practice Address - Fax:330-872-7372
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-04923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0956112Medicaid
OH0956112Medicaid