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General NPI Number Information
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NPI Number | 1720438690
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Entity Type | Organization
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Legal Business Name | SQUARE ONE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 4543 MCKNIGHT RD
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City | PITTSBURGH
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State | PA
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Zip | 15237-3108
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Country | US
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Telephone | 412-748-1616
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 E ELFINWILD RD
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City | ALLISON PARK
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State | PA
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Zip | 15101-3915
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Country | US
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Telephone | 412-748-1616
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Fax | 412-213-0881
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | GORDON RIDDLE
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Credential | PT
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Telephone | 412-760-4874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT017595
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License Number State | PA
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