Healthcare Provider Details

I. General information

NPI: 1669519880
Provider Name (Legal Business Name): SEWICKLEY PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 LANTERN LN
SEWICKLEY PA
15143-2042
US

IV. Provider business mailing address

618 BEAVER ST 202
SEWICKLEY PA
15143-1906
US

V. Phone/Fax

Practice location:
  • Phone: 412-749-7884
  • Fax:
Mailing address:
  • Phone: 412-749-7884
  • Fax: 412-749-4884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number800875E
License Number StatePA

VIII. Authorized Official

Name: GAYLE DAVIS
Title or Position: MANAGER OWNER
Credential: LPT
Phone: 412-749-7884