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General NPI Number Information
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NPI Number | 1255210100
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Entity Type | Organization
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Legal Business Name | OMNIA FUNCTION LLC
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 533 VINELAND RD
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City | BAY VILLAGE
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State | OH
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Zip | 44140-2873
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Country | US
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Telephone | 419-366-3163
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Fax |
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Provider Business Mailing Address
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Address Line | 533 VINELAND RD
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City | BAY VILLAGE
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State | OH
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Zip | 44140-2873
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Country | US
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Telephone | 419-366-3163
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Fax |
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Authorized Official
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Title or Position | CEO AND CO-FOUNDER - PT
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Name | DR. MICHAEL K. E. BOGDEN
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Credential | DPT
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Telephone | 419-366-3163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number |
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License Number State |
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