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General NPI Number Information
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NPI Number | 1992957625
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Entity Type | Individual
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Provider Name | MR. DOUGLAS M HAVRILESKO
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Gender | Male
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Dates
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Enumeration Date | 10/13/2008
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Last Update Date | 10/13/2008
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Provider Practice Location Address
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Address Line | 60 HIGHLAND RD
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City | BETHEL PARK
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State | PA
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Zip | 15102-1806
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Country | US
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Telephone | 421-831-6050
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Fax |
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Provider Business Mailing Address
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Address Line | 261 SUNSET BLVD
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City | WASHINGTON
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State | PA
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Zip | 15301-1260
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Country | US
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Telephone | 724-222-8549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TE001786L
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License Number State | PA
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