Healthcare Provider Details

I. General information

NPI: 1972501757
Provider Name (Legal Business Name): MAHONING PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 FRANKLIN ST
CLYMER PA
15728-1174
US

IV. Provider business mailing address

405 FRANKLIN ST P O BOX 153
CLYMER PA
15728-1174
US

V. Phone/Fax

Practice location:
  • Phone: 724-254-1010
  • Fax:
Mailing address:
  • Phone: 724-254-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT000800E
License Number StatePA

VIII. Authorized Official

Name: MRS. MARY AGNES FLETCHER
Title or Position: PRESIDENT
Credential: PT
Phone: 724-254-1010