Healthcare Provider Details

I. General information

NPI: 1376668608
Provider Name (Legal Business Name): WESTERN PENNSYLVANIA REHAB ASSOCIATES,LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 WATERDAM RD SUITE 240
MC MURRAY PA
15317-2576
US

IV. Provider business mailing address

159 WATERDAM RD SUITE 240
MC MURRAY PA
15317-2576
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-8702
  • Fax: 724-941-9089
Mailing address:
  • Phone: 724-941-8702
  • Fax: 724-941-9089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberMD037589E
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0011527870003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. CYNTHIA L DIMAURO
Title or Position: OWNER
Credential: MD
Phone: 724-941-8702