Healthcare Provider Details

I. General information

NPI: 1811128895
Provider Name (Legal Business Name): RACHEL L LONG PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL KINSUGAR PHYSICAL THERAPIST

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 GREENFIELD AVE
PITTSBURGH PA
15217
US

IV. Provider business mailing address

625 LINCOLN AVE SUITE 107
NORTH CHARLEROI PA
15022
US

V. Phone/Fax

Practice location:
  • Phone: 412-422-7022
  • Fax: 724-483-0519
Mailing address:
  • Phone: 724-483-3610
  • Fax: 724-489-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019937
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019937
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: