1619245719 NPI number — TRI RIVERS PHYSICAL THERAPY LLC

Table of content: (NPI 1619245719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619245719 NPI number — TRI RIVERS PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI RIVERS PHYSICAL THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619245719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9104 BABCOCK BLVD
Provider Second Line Business Mailing Address:
SUITE 2120
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237-5818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-367-2760
Provider Business Mailing Address Fax Number:
412-847-0077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 CLEARVIEW CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16001-1565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-367-5814
Provider Business Practice Location Address Fax Number:
412-367-1572
Provider Enumeration Date:
12/05/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BECKWITH
Authorized Official First Name:
ROBYN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
412-367-0979

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)