MEDICARE: THOMAS FEDORKO PTA

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	225200000X	Physical Therapy Assistant	TE1002873	PA

General Provider Information

NPI Number	:	1265986111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS FEDORKO PTA

Provider Business Mailing Address
First Line	:	725 CHERRINGTON PKWY
Second Line	:
City	:	MOON TWP
State	:	PA
Zip	:	15108-4318
Country	:	US
Telephone Number	:	412-264-6192
Fax Number	:	412-264-6196

Provider Business Practice Location Address
First Line	:	725 CHERRINGTON PKWY
Second Line	:	SUITE 201
City	:	MOON TWP
State	:	PA
Zip	:	15108-4318
Country	:	US
Telephone Number	:	412-264-6192
Fax Number	:	412-264-6196

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

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	08/09/2016

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Directions to “ THOMAS FEDORKO PTA” Practice Location

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