MEDICARE: JOSEPH DISTEL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT-04742	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00178552	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04764	OTHER	OH	PARAMOUNT
2	DI4057732	OTHER	OH	ADMINISTAR FEDERAL
4	000000355382	OTHER	OH	ANTHEM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	28862522000	OTHER	OH	BUREAU OF WORKERS COMP

General Provider Information

NPI Number	:	1629006556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH DISTEL PT

Provider Business Mailing Address
First Line	:	8437 LAKEBROOK DR
Second Line	:
City	:	FINDLAY
State	:	OH
Zip	:	45840-8870
Country	:	US
Telephone Number	:	419-422-5526
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 WESTERN AVE STE B
Second Line	:
City	:	FINDLAY
State	:	OH
Zip	:	45840-1390
Country	:	US
Telephone Number	:	419-422-5526
Fax Number	:	419-422-5562

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	01/17/2017

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Directions to “ JOSEPH DISTEL PT” Practice Location

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