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NPI Code Detail

MEDICARE: WENDY MARIE MUSSOMELI PTA

MEDICARE: WENDY MARIE MUSSOMELI 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
1225200000XPhysical Therapy AssistantTE004065PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1TE004065LOTHERPAPTA LICENSE

General Provider Information

NPI Number : 1366568537
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY MARIE MUSSOMELI PTA
Provider Business Mailing Address
First Line : 3138 BROADWAY AVE
Second Line :
City : PITTSBURGH
State : PA
Zip : 15234-2721
Country : US
Telephone Number : 412-207-4999
Fax Number :
Provider Business Practice Location Address
First Line : 3590 WASHINGTON PIKE
Second Line :
City : BRIDGEVILLE
State : PA
Zip : 15017-1047
Country : US
Telephone Number : 412-257-2474
Fax Number : 412-257-4521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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