Healthcare Provider Details

I. General information

NPI: 1902769219
Provider Name (Legal Business Name): EMILY ELISE FAGNELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ELISE GORDON

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DUFF RD FL 1
PITTSBURGH PA
15235-3260
US

IV. Provider business mailing address

1504 BARRY DR
IRWIN PA
15642-1745
US

V. Phone/Fax

Practice location:
  • Phone: 412-247-4117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE013866
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: