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General NPI Number Information
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NPI Number | 1972880243
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Entity Type | Organization
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Legal Business Name | ELITE PERFORMANCE PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 7051 STEUBENVILLE PIKE SUITE 2
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City | OAKDALE
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State | PA
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Zip | 15071-3318
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Country | US
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Telephone | 412-788-4626
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Fax | 412-788-4335
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Provider Business Mailing Address
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Address Line | 7051 STEUBENVILLE PIKE SUITE 2
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City | OAKDALE
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State | PA
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Zip | 15071-1509
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Country | US
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Telephone | 412-788-4626
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Fax | 412-788-4335
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. FRED R LUTZ JR.
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Credential |
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Telephone | 412-788-4626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT-006821L
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License Number State | PA
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