Healthcare Provider Details

I. General information

NPI: 1245660018
Provider Name (Legal Business Name): ALBERT SUCILLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W RUN RD
MUNHALL PA
15120-2869
US

IV. Provider business mailing address

1255 SHADYCREST DR
PITTSBURGH PA
15216-3017
US

V. Phone/Fax

Practice location:
  • Phone: 412-462-8002
  • Fax: 412-462-2113
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI000760
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: