1649200791 NPI number — PITTSVILLE THERAPY SERVICES, INC

Table of content: (NPI 1649200791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649200791 NPI number — PITTSVILLE THERAPY SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PITTSVILLE THERAPY SERVICES, 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:
1649200791
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:
PO BOX 276
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54466-0276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-884-2333
Provider Business Mailing Address Fax Number:
715-884-2333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5308 SECOND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54466-0276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-884-2333
Provider Business Practice Location Address Fax Number:
715-884-2333
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ORGEL REEVES
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
715-884-2333

Provider Taxonomy Codes

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

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

  • Identifier: 40418400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com