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General NPI Number Information
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NPI Number | 1629009048
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Entity Type | Organization
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Legal Business Name | CLINICAL THERAPEUTICS INC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 2265 MARKET STREET SUITE A
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City | WARREN
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State | PA
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Zip | 16365-4682
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Country | US
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Telephone | 814-726-9050
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Fax | 814-726-9629
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Provider Business Mailing Address
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Address Line | 2265 MARKET STREET SUITE A
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City | WARREN
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State | PA
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Zip | 16365-4682
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Country | US
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Telephone | 814-726-9050
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Fax | 814-726-9629
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | CARL ANDREW SANDSTROM
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Credential | MSPT
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Telephone | 814-726-9050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251E1300X
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Taxonomy Name | Clinical Electrophysiology Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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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