Provider Demographics
NPI:1487603940
Name:JAWORSKI, MICHAEL J (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:JAWORSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:137 WINCKLES STREET
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035
Mailing Address - Country:US
Mailing Address - Phone:440-366-5993
Mailing Address - Fax:440-366-5313
Practice Address - Street 1:137 WINCKLES STREET
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-366-5993
Practice Address - Fax:440-366-5313
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT02337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4297901OtherMEDICARE PTAN
OH341490517034OtherCARESOURCE
OH654140OtherAETNA
OH000000132802OtherANTHEM BLUECROSS BLUESHIE
OH34149051700OtherOHIO BUREAU OF WORKERS CO