Healthcare Provider Details

I. General information

NPI: 1114429545
Provider Name (Legal Business Name): IRON CITY PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 PENNWOOD AVE STE 201A
PITTSBURGH PA
15221-3308
US

IV. Provider business mailing address

203 VERMILLION DR
PITTSBURGH PA
15209-2157
US

V. Phone/Fax

Practice location:
  • Phone: 503-453-2900
  • Fax:
Mailing address:
  • Phone: 503-453-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT024008
License Number StatePA

VIII. Authorized Official

Name: DR. KEVIN DAVID
Title or Position: OWNER PHYSICAL THERAPIST
Credential: DPT
Phone: 503-453-2900