Healthcare Provider Details

I. General information

NPI: 1538925847
Provider Name (Legal Business Name): ANTHONY JOHN FATEBENE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W EDISON AVE
NEW CASTLE PA
16101-2174
US

IV. Provider business mailing address

408 MEADOW VIEW LN
BUTLER PA
16001-1450
US

V. Phone/Fax

Practice location:
  • Phone: 724-652-6340
  • Fax:
Mailing address:
  • Phone: 412-629-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: