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General NPI Number Information
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NPI Number | 1093361610
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Entity Type | Organization
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Legal Business Name | STAWECKI PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/11/2019
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Last Update Date | 08/11/2019
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Provider Practice Location Address
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Address Line | 207 NORTH TRL
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City | BUTLER
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State | PA
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Zip | 16002-7609
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Country | US
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Telephone | 724-504-6536
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 597
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City | VALENCIA
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State | PA
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Zip | 16059-0597
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Country | US
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Telephone | 724-931-3646
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MARK STAWECKI
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Credential | PT
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Telephone | 724-504-6536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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