Healthcare Provider Details

I. General information

NPI: 1174973283
Provider Name (Legal Business Name): VALERIE AZZAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12620 PERRY HWY
WEXFORD PA
15090-8662
US

IV. Provider business mailing address

300 CHAPEL HARBOR DR
PITTSBURGH PA
15238-4131
US

V. Phone/Fax

Practice location:
  • Phone: 724-933-6677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT025191
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: