Healthcare Provider Details

I. General information

NPI: 1669456034
Provider Name (Legal Business Name): PATRICIA A PERSIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 OLD WILLIAM PENN HWY
BLAIRSVILLE PA
15717-7855
US

IV. Provider business mailing address

430 INNOVATION DRIVE
BLAIRSVILLE PA
15717-8096
US

V. Phone/Fax

Practice location:
  • Phone: 724-459-6111
  • Fax: 724-459-0355
Mailing address:
  • Phone: 724-343-4060
  • Fax: 724-343-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: