1821051236 NPI number — MR. JOSEPH R CHRILLO M.S., P.T.

Table of content: MR. JOSEPH R CHRILLO M.S., P.T. (NPI 1821051236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821051236 NPI number — MR. JOSEPH R CHRILLO M.S., P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRILLO
Provider First Name:
JOSEPH
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S., P.T.
Provider Gender Code:
M

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:
1821051236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
438 PELLIS RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-7900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-850-7587
Provider Business Mailing Address Fax Number:
724-850-9909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4576 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:
15668-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-325-1610
Provider Business Practice Location Address Fax Number:
724-733-2703
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT002605L , 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: 0015999900004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0015999900003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com