MEDICARE: RACHEL MARIE MIGNOGNA P.T.

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	PT003753L	PA

General Provider Information

NPI Number	:	1841523396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MARIE MIGNOGNA P.T.

Provider Business Mailing Address
First Line	:	816 HASTINGS ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1335
Country	:	US
Telephone Number	:	412-421-8212
Fax Number	:

Provider Business Practice Location Address
First Line	:	2344 PERRYSVILLE AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15214-3560
Country	:	US
Telephone Number	:	412-321-4139
Fax Number	:

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

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	09/16/2009

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