Healthcare Provider Details

I. General information

NPI: 1801883020
Provider Name (Legal Business Name): ELK REGIONAL PROFESSIONAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 JOHNSONBURG RD
ST MARYS PA
15857-3417
US

IV. Provider business mailing address

763 JOHNSONBURG RD
ST MARYS PA
15857-3417
US

V. Phone/Fax

Practice location:
  • Phone: 814-788-8580
  • Fax: 814-788-8042
Mailing address:
  • Phone: 814-788-8580
  • Fax: 814-788-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RITA V OLSZEWSKI
Title or Position: VICE PRESIDENT, ERPG
Credential:
Phone: 814-788-8580