Healthcare Provider Details

I. General information

NPI: 1336382183
Provider Name (Legal Business Name): MATTHEW V BAIR I PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 LINCOLN AVE SUITE 107 PROFESSIONAL PLAZA
N CHARLEROI PA
15022-2451
US

IV. Provider business mailing address

625 LINCOLN AVE SUITE 107 PROFESSIONAL PLAZA
N CHARLEROI PA
15022-2451
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-4886
  • Fax: 724-483-0290
Mailing address:
  • Phone: 724-483-4886
  • Fax: 724-483-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019740
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: