Healthcare Provider Details

I. General information

NPI: 1083853329
Provider Name (Legal Business Name): DISEPIO INSTITUTE FOR RURAL HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 FRANCISCAN WAY
LORETTO PA
15940-0600
US

IV. Provider business mailing address

PO BOX 600 108 FRANCISCAN WAY
LORETTO PA
15940-0600
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-3936
  • Fax: 814-472-3905
Mailing address:
  • Phone: 814-472-3199
  • Fax: 814-472-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. MICHAEL B ARNALL
Title or Position: EXECUTIVE DIRECTOR
Credential: PT, MS, MBA
Phone: 814-472-3199