1013037720 NPI number — ALTRU PHYSICAL THERAPY, INC.

Table of content: MRS. KELLY MARIE SANDOVAL DPT (NPI 1306096987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013037720 NPI number — ALTRU PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTRU PHYSICAL THERAPY, INC.
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:
1013037720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4125 WILLIAM PENN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRYSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15668-1847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-386-1007
Provider Business Mailing Address Fax Number:
724-387-1009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4125 WILLIAM PENN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRYSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15668-1847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-386-1007
Provider Business Practice Location Address Fax Number:
724-387-1009
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOMOROSKI
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER, PRESIDENT
Authorized Official Telephone Number:
724-387-1007

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  PTO5422L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1962437889 . This is a "NPI GREGORY KOMOROSKI PT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: RI1742951 . This is a "BC IDENTIFICATION #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 515166 . This is a "PROVIDER BC ID #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1033141452 . This is a "NPI MICHAEL RICCHIUTO MPT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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