Healthcare Provider Details

I. General information

NPI: 1063761625
Provider Name (Legal Business Name): PENN NEUROMUSCULAR DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRADDOCK ROAD AVE SUITE C
MT PLEASANT PA
15666-1458
US

IV. Provider business mailing address

9 N 7TH ST 2ND FLOOR, TOWNPLACE VICTORIA
INDIANA PA
15701-1880
US

V. Phone/Fax

Practice location:
  • Phone: 724-801-8894
  • Fax: 724-465-6032
Mailing address:
  • Phone: 724-801-8894
  • Fax: 724-465-6032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: THOMAS W ZAUCHA
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 724-801-8894