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General NPI Number Information
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NPI Number | 1093989709
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Entity Type | Organization
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Legal Business Name | JUST KIDS REHABILITATION SERVICES LLC
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 1750 NEW BUTLER RD SUITE D
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City | NEW CASTLE
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State | PA
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Zip | 16101-3184
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Country | US
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Telephone | 724-971-1021
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 594
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City | WAMPUM
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State | PA
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Zip | 16157-0594
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Country | US
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Telephone | 724-630-5607
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. WILLIAM J SHUTTLEWORTH
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Credential | P.T
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Telephone | 724-971-1021
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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 | PT016373
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License Number State | PA
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