Healthcare Provider Details

I. General information

NPI: 1154573491
Provider Name (Legal Business Name): CAROL ANN VIGNA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5609 5TH AVE
PITTSBURGH PA
15232-2601
US

IV. Provider business mailing address

1805 HORIZON DR
MCKEESPORT PA
15131-2215
US

V. Phone/Fax

Practice location:
  • Phone: 412-362-3500
  • Fax:
Mailing address:
  • Phone: 412-678-0325
  • Fax: 412-672-1579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT005827L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: