MEDICARE: PITTSBURGH PELVIC HEALTH, LLC

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

General Provider Information

NPI Number	:	1386117091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PITTSBURGH PELVIC HEALTH, LLC

Provider Business Mailing Address
First Line	:	1728 GROVE CREST DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15239-1146
Country	:	US
Telephone Number	:	570-772-7936
Fax Number	:

Provider Business Practice Location Address
First Line	:	1728 GROVE CREST DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15239-1146
Country	:	US
Telephone Number	:	570-772-7936
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SARINA DUMBLETON BEASLEY
Credential	:	PT, DPT, WCS, CLT
Telephone Number	:	570-772-7936

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	01/04/2019

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