Provider Demographics
NPI:1144506098
Name:MIKE FURDA, LLC
Entity type:Organization
Organization Name:MIKE FURDA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FURDA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:740-266-6855
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3734
Mailing Address - Country:US
Mailing Address - Phone:740-264-0661
Mailing Address - Fax:740-264-4376
Practice Address - Street 1:426 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:WV
Practice Address - Zip Code:26034-1130
Practice Address - Country:US
Practice Address - Phone:740-266-6855
Practice Address - Fax:740-275-4182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT000804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000804OtherPT LICENSE