MEDICARE: MR. MICHAEL D PIEKUTOSKI MPT

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	PT0109890	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	167651	OTHER	PA	BLUE CROSS

General Provider Information

NPI Number	:	1366408825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL D PIEKUTOSKI MPT

Provider Business Mailing Address
First Line	:	715 BUSH DR
Second Line	:
City	:	MARS
State	:	PA
Zip	:	16046-4821
Country	:	US
Telephone Number	:	412-310-4009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 WEST ST
Second Line	:
City	:	HOMESTEAD
State	:	PA
Zip	:	15120-2578
Country	:	US
Telephone Number	:	412-476-8436
Fax Number	:	412-476-8439

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	07/08/2007

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