Healthcare Provider Details

I. General information

NPI: 1245408442
Provider Name (Legal Business Name): CHERRY TREE MEDICAL ASSOC PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HIGHLAND PARK DR
UNIONTOWN PA
15401-8922
US

IV. Provider business mailing address

20 HIGHLAND PARK DR
UNIONTOWN PA
15401-8922
US

V. Phone/Fax

Practice location:
  • Phone: 724-438-1810
  • Fax: 724-438-2011
Mailing address:
  • Phone: 724-438-1810
  • Fax: 724-438-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1913125
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1913125
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK

VIII. Authorized Official

Name: MARTI L BEAZELL
Title or Position: BILLING MANAGER
Credential:
Phone: 724-439-4531