Healthcare Provider Details

I. General information

NPI: 1245476118
Provider Name (Legal Business Name): 180 PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2008
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 STERRETTANIA RD
ERIE PA
16506
US

IV. Provider business mailing address

3740 STERRETTANIA RD
ERIE PA
16506-2829
US

V. Phone/Fax

Practice location:
  • Phone: 814-838-9180
  • Fax: 814-838-6180
Mailing address:
  • Phone: 814-838-9180
  • Fax: 814-838-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT018397
License Number StatePA

VIII. Authorized Official

Name: MR. JOHN DEANGELO
Title or Position: PRESIDENT
Credential: MPT, ATC
Phone: 814-504-2973