MEDICARE: P&G PHYSICAL THERAPY, INC

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	PT008866L	PA

General Provider Information

NPI Number	:	1922079961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P&G PHYSICAL THERAPY, INC

Provider Business Mailing Address
First Line	:	602 W DUBOIS AVE
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-3905
Country	:	US
Telephone Number	:	814-375-6830
Fax Number	:	814-375-6832

Provider Business Practice Location Address
First Line	:	602 W DUBOIS AVE
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-3905
Country	:	US
Telephone Number	:	814-375-6830
Fax Number	:	814-375-6832

Authorized Official
Title or Position	:	OWNER
Name	:	MR. EDWARD LEE WELCH
Credential	:	MPT
Telephone Number	:	814-375-6830

Provider Enumeration Date	:	01/29/2006
Last Update Date	:	08/22/2020

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