Healthcare Provider Details

I. General information

NPI: 1447321856
Provider Name (Legal Business Name): GUADALUPE M ROVITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 OXFORD DR SUITE 1F
BETHEL PARK PA
15102-1896
US

IV. Provider business mailing address

212 SNOWBERRY CIR
VENETIA PA
15367-1042
US

V. Phone/Fax

Practice location:
  • Phone: 412-851-8850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL002190L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: