Healthcare Provider Details

I. General information

NPI: 1255395166
Provider Name (Legal Business Name): PATRIOT PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2279B MAIN STREET
MUNHALL PA
15120
US

IV. Provider business mailing address

4609 EASY STREET
WEST MIFFLIN PA
15122-1966
US

V. Phone/Fax

Practice location:
  • Phone: 412-462-1191
  • Fax: 412-462-1182
Mailing address:
  • Phone: 412-462-1191
  • Fax: 412-462-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY BORNAK
Title or Position: OWNER/PT
Credential: MPT
Phone: 412-462-2330