1255350286 NPI number — METRO ORTHOPEDIC PHYSICAL THERAPY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255350286 NPI number — METRO ORTHOPEDIC PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO ORTHOPEDIC 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:
ROBERT BAKER EMG AND NERVE CONDUCTION SERVICES
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:
1255350286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 PEBBLE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC KEES ROCKS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15136-1083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-787-3293
Provider Business Mailing Address Fax Number:
412-787-1821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 INTERSTATE PKWY STE 32
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16701-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-787-3293
Provider Business Practice Location Address Fax Number:
412-787-1821
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
412-787-3293

Provider Taxonomy Codes

  • Taxonomy code: 2251E1300X , with the licence number:  PT000789E , 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: 695158 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001572146 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0111196 . This is a "AETNA USHEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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