Healthcare Provider Details

I. General information

NPI: 1689636581
Provider Name (Legal Business Name): ORTHOPEDIC & SPORTS PHYSICAL THERAPY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 LINCOLN AVE PROFESSIONAL PLAZA, STE 208
CHARLEROI PA
15022-2451
US

IV. Provider business mailing address

625 LINCOLN AVE PROFESSIONAL PLAZA, STE 208
CHARLEROI PA
15022-2451
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-4886
  • Fax: 724-483-0519
Mailing address:
  • Phone: 724-483-4886
  • Fax: 724-483-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JODY HENSON
Title or Position: PT
Credential: P.T
Phone: 724-483-3361