Provider Demographics
NPI:1487687125
Name:NORTHWEST PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:NORTHWEST PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-523-9003
Mailing Address - Street 1:1880 N PERRY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1129
Mailing Address - Country:US
Mailing Address - Phone:419-523-9003
Mailing Address - Fax:419-523-9143
Practice Address - Street 1:1880 N PERRY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1129
Practice Address - Country:US
Practice Address - Phone:419-523-9003
Practice Address - Fax:419-523-9143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2251343Medicaid
OH=========Medicare UPIN
OH2251343Medicaid