Provider Demographics
NPI:1457423816
Name:PT WORKS OF WAPAKONETA INC
Entity type:Organization
Organization Name:PT WORKS OF WAPAKONETA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:419-738-9675
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-0101
Mailing Address - Country:US
Mailing Address - Phone:419-738-9675
Mailing Address - Fax:567-356-4334
Practice Address - Street 1:410 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-7739
Practice Address - Country:US
Practice Address - Phone:419-738-9675
Practice Address - Fax:567-356-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0882979Medicaid
OH0712931Medicare ID - Type UnspecifiedPROVIDER NUMBER