Healthcare Provider Details

I. General information

NPI: 1568737039
Provider Name (Legal Business Name): KEVIN GREGORY DAVID DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 PENNWOOD AVE
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 TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number38521
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT024008
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: