MEDICARE: OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST PA

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1457791204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST PA

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR
Second Line	:	SUITE 1200 WEST
City	:	ADDISON
State	:	TX
Zip	:	75001-4648
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2485 FORT CAMPBELL BLVD
Second Line	:	SUITE 104
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-7787
Country	:	US
Telephone Number	:	931-241-4391
Fax Number	:	931-241-4639

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT HASSETT
Credential	:	DO, MPH
Telephone Number	:	972-720-7906

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	04/09/2015

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