Healthcare Provider Details

I. General information

NPI: 1629009048
Provider Name (Legal Business Name): CLINICAL THERAPEUTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 MARKET STREET SUITE A
WARREN PA
16365-4682
US

IV. Provider business mailing address

2265 MARKET STREET SUITE A
WARREN PA
16365-4682
US

V. Phone/Fax

Practice location:
  • Phone: 814-726-9050
  • Fax: 814-726-9629
Mailing address:
  • Phone: 814-726-9050
  • Fax: 814-726-9629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARL ANDREW SANDSTROM
Title or Position: OWNER/DIRECTOR
Credential: MSPT
Phone: 814-726-9050