Healthcare Provider Details

I. General information

NPI: 1588828313
Provider Name (Legal Business Name): LAWRENCE COUNTY ORTHOPEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 WILMINGTON RD B
NEW CASTLE PA
16105-1168
US

IV. Provider business mailing address

3120 WILMINGTON RD B
NEW CASTLE PA
16105-1168
US

V. Phone/Fax

Practice location:
  • Phone: 724-657-6852
  • Fax: 724-657-8945
Mailing address:
  • Phone: 724-657-6852
  • Fax: 724-657-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007700L
License Number StatePA

VIII. Authorized Official

Name: DR. ROBERT D MCGANN
Title or Position: MANAGING PARTNER
Credential: D.O.
Phone: 724-658-5311