Provider Demographics
NPI:1699759407
Name:MISCHNICK, JEFFREY D (PT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:MISCHNICK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7567 CENTRAL PARKE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6855
Mailing Address - Country:US
Mailing Address - Phone:513-701-6100
Mailing Address - Fax:513-701-6106
Practice Address - Street 1:4464 INDIAN RIPPLE RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3252
Practice Address - Country:US
Practice Address - Phone:937-426-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 009037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9408413OtherPHCS
OH2611472Medicaid
OH000000378630OtherANTHEM
OHP00378174OtherMEDICARE RAILROAD
OH0224920002Medicare NSC
OHMI4152042Medicare PIN