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General NPI Number Information
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NPI Number | 1669519880
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Entity Type | Organization
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Legal Business Name | SEWICKLEY PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 405 LANTERN LN
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City | SEWICKLEY
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State | PA
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Zip | 15143-2042
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Country | US
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Telephone | 412-749-7884
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Fax |
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Provider Business Mailing Address
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Address Line | 618 BEAVER ST 202
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City | SEWICKLEY
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State | PA
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Zip | 15143-1906
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Country | US
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Telephone | 412-749-7884
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Fax | 412-749-4884
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Authorized Official
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Title or Position | MANAGER OWNER
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Name | GAYLE DAVIS
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Credential | LPT
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Telephone | 412-749-7884
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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 | 800875E
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License Number State | PA
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