1629009048 NPI number — CLINICAL THERAPEUTICS INC

Table of content: (NPI 1629009048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629009048 NPI number — CLINICAL THERAPEUTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL THERAPEUTICS 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:
CTI PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1629009048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2265 MARKET STREET
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16365-4682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-726-9050
Provider Business Mailing Address Fax Number:
814-726-9629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2265 MARKET STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16365-4682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-726-9050
Provider Business Practice Location Address Fax Number:
814-726-9629
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANDSTROM
Authorized Official First Name:
CARL
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
814-726-9050

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251E1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1007362470012 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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