Healthcare Provider Details

I. General information

NPI: 1780792788
Provider Name (Legal Business Name): MED ICAL TECHNICAL REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 COMPASS CIRCLE
GREENSBURG PA
15601-2682
US

IV. Provider business mailing address

1037 COMPASS CIRCLE
GREENSBURG PA
15601-2682
US

V. Phone/Fax

Practice location:
  • Phone: 724-834-1144
  • Fax: 724-834-2077
Mailing address:
  • Phone: 724-834-1144
  • Fax: 724-834-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number657045
License Number StatePA

VIII. Authorized Official

Name: MR. THOMAS PLAITANO
Title or Position: PROJECT DIRECTOR
Credential:
Phone: 724-834-1144