Active NPI
Angela Formanik, DPT
- Physical Therapist
- Cleveland, OH
National Provider Identifier
1164989679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT017896
- Practice address
- 7201 Wade Park Ave
Cleveland, OH 44103-2765 - Phone
- (216) 361-6141
- NPI assigned
- Feb 21, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT017896 | OH | Primary |
Addresses
Primary practice location
7201 Wade Park Ave
Cleveland, OH 44103-2765
Mailing address
330 Chesapeake CV
Painesville, OH 44077-1370
Phone (440) 251-2741
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT017896 | OH | MD | Physical Therapist |
Interoperability endpoints
- aformanik38867@ehrdirect.uhhospitals.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550707200000",
"number": "1164989679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 CHESAPEAKE CV",
"city": "PAINESVILLE",
"state": "OH",
"postal_code": "440771370",
"telephone_number": "440-251-2741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7201 WADE PARK AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441032765",
"telephone_number": "216-361-6141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMANIK",
"first_name": "ANGELA",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-21",
"last_updated": "2019-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "PT017896",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.