Healthcare Provider Details

I. General information

NPI: 1790284263
Provider Name (Legal Business Name): MORGAN GRACE BROSNIHAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 NEW GERMANY RD
EBENSBURG PA
15931-3516
US

IV. Provider business mailing address

245 N RIDGE RD
MC HENRY MD
21541-1122
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-1100
  • Fax:
Mailing address:
  • Phone: 301-501-0993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026711
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: