Healthcare Provider Details

I. General information

NPI: 1417209693
Provider Name (Legal Business Name): A-K VALLEY PHYSICAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 WILDLIFE LODGE RD
LOWER BURRELL PA
15068-3562
US

IV. Provider business mailing address

1170 WILDLIFE LODGE RD
LOWER BURRELL PA
15068-3562
US

V. Phone/Fax

Practice location:
  • Phone: 724-339-0370
  • Fax:
Mailing address:
  • Phone: 724-339-0370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS014379
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ALEC CIRIGLIANO
Title or Position: CO-OWNER
Credential:
Phone: 724-339-0370