MEDICARE: SANDRA MCCOOL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT010859L	PA

General Provider Information

NPI Number	:	1225355159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MCCOOL PT

Provider Business Mailing Address
First Line	:	16 INDUSTRIAL BLVD
Second Line	:	203
City	:	PAOLI
State	:	PA
Zip	:	19301-1609
Country	:	US
Telephone Number	:	484-595-9300
Fax Number	:	484-593-0365

Provider Business Practice Location Address
First Line	:	5830 ELLSWORTH AVE
Second Line	:	201
City	:	PITTSBURGH
State	:	PA
Zip	:	15232-1778
Country	:	US
Telephone Number	:	484-595-9300
Fax Number	:	484-593-0365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	05/03/2010

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