Healthcare Provider Details

I. General information

NPI: 1689706129
Provider Name (Legal Business Name): JEREMY PAUL HUTH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CARLISLE ST
NATRONA HEIGHTS PA
15065-1152
US

IV. Provider business mailing address

158 BLACKSTONE RD
LEECHBURG PA
15656-9340
US

V. Phone/Fax

Practice location:
  • Phone: 724-226-7302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018134
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: