=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548681372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE PHYSICAL THERAPY INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2013
-----------------------------------------------------
Last Update Date | 12/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 708 WARRENDALE VILLAGE DRIVE
-----------------------------------------------------
City | WARRENDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15086-6516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-719-2326
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 480 JOHNSON RD SUITE 303
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15301-8936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-223-2061
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RYAN CHRISTOFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-223-2061
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------