Healthcare Provider Details

I. General information

NPI: 1912506296
Provider Name (Legal Business Name): JARED WALTER TODOROWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 NEW GERMANY RD
EBENSBURG PA
15931-3516
US

IV. Provider business mailing address

4408 GRANDVIEW DR
GIBSONIA PA
15044-5316
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-1100
  • Fax:
Mailing address:
  • Phone: 412-735-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028779
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: