Provider Demographics
NPI:1588121883
Name:CHLEBOWSKI, MICHEAEL GERARD
Entity type:Individual
Prefix:MR
First Name:MICHEAEL
Middle Name:GERARD
Last Name:CHLEBOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 HEIDELBERG RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-4619
Mailing Address - Country:US
Mailing Address - Phone:567-868-6721
Mailing Address - Fax:
Practice Address - Street 1:4560 W ALEXIS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-1082
Practice Address - Country:US
Practice Address - Phone:567-868-6721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA009507225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant