Healthcare Provider Details

I. General information

NPI: 1336216332
Provider Name (Legal Business Name): DAMON ANTHONY FORMAINI MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FRANKLIN VILLAGE MALL
KITTANNING PA
16201-8803
US

IV. Provider business mailing address

430 INNOVATION DRIVE
BLAIRSVILLE PA
15717-8096
US

V. Phone/Fax

Practice location:
  • Phone: 724-543-6452
  • Fax: 724-543-5617
Mailing address:
  • Phone: 724-343-4060
  • Fax: 724-343-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010972L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: