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General NPI Number Information
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NPI Number | 1245476118
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Entity Type | Organization
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Legal Business Name | 180 PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 12/26/2008
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 3740 STERRETTANIA RD
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City | ERIE
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State | PA
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Zip | 16506
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Country | US
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Telephone | 814-838-9180
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Fax | 814-838-6180
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Provider Business Mailing Address
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Address Line | 3740 STERRETTANIA RD
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City | ERIE
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State | PA
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Zip | 16506-2829
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Country | US
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Telephone | 814-838-9180
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Fax | 814-838-6180
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN DEANGELO
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Credential | MPT, ATC
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Telephone | 814-504-2973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT018397
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License Number State | PA
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