Healthcare Provider Details

I. General information

NPI: 1558762781
Provider Name (Legal Business Name): ZACHARY BLAHOVEC PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 LEBANON AVE
UNIONTOWN PA
15401-4127
US

IV. Provider business mailing address

625 LINCOLN AVE SUITE 209
N CHARLEROI PA
15022-2451
US

V. Phone/Fax

Practice location:
  • Phone: 724-439-6294
  • Fax: 724-439-8947
Mailing address:
  • Phone: 724-483-3610
  • Fax: 724-489-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT023849
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: