MEDICARE: KELSEY STOTTLEMYER PUST DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PY025102	PA

General Provider Information

NPI Number	:	1174978993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY STOTTLEMYER PUST DPT

Provider Business Mailing Address
First Line	:	414 ROUTE 71
Second Line	:
City	:	CHARLEROI
State	:	PA
Zip	:	15022
Country	:	US
Telephone Number	:	724-825-5501
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 GREENSBURG PIKE
Second Line	:
City	:	WEST NEWTON
State	:	PA
Zip	:	15089-2060
Country	:	US
Telephone Number	:	724-872-0356
Fax Number	:	724-872-6051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	04/29/2016

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