Healthcare Provider Details

I. General information

NPI: 1578996716
Provider Name (Legal Business Name): SEAN ANTHONY GDULA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 FRANCISCAN WAY
LORETTO PA
15940-9703
US

IV. Provider business mailing address

932 JEFFERSON AVE.
BEAVERDALE PA
15921-0077
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-3936
  • Fax:
Mailing address:
  • Phone: 814-242-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT023000
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: