Healthcare Provider Details

I. General information

NPI: 1154528925
Provider Name (Legal Business Name): JASON MCINTYRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HOLLAND AVE
BRADDOCK PA
15104-1599
US

IV. Provider business mailing address

3308 JULIET ST
PITTSBURGH PA
15213-4422
US

V. Phone/Fax

Practice location:
  • Phone: 412-636-5090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018782
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: