1417145335 NPI number — PHYSIOTHERAPY ASSOCIATES, 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 1417145335 NPI number — PHYSIOTHERAPY ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSIOTHERAPY ASSOCIATES, 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:
6
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:
1417145335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
665 PHILADELPHIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15701-3941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-465-3496
Provider Business Mailing Address Fax Number:
724-465-3726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4860 PLAZA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLERTOWN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39667-9221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-876-3501
Provider Business Practice Location Address Fax Number:
601-876-3503
Provider Enumeration Date:
10/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POOL
Authorized Official First Name:
JAYNE
Authorized Official Middle Name:
FLECK
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
469-467-8705

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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