Healthcare Provider Details

I. General information

NPI: 1568616514
Provider Name (Legal Business Name): ORTHOPEDIC & SPORTS PHYSICAL THERAPY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 STOOPS DR SUITE 280
MONONGAHELA PA
15063-3553
US

IV. Provider business mailing address

100 STOOPS DR SUITE 280
MONONGAHELA PA
15063-3553
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-4263
  • Fax: 724-483-3154
Mailing address:
  • Phone: 724-483-4263
  • Fax: 724-483-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. JODY HENSON
Title or Position: PT
Credential: PT
Phone: 724-483-3361