Provider Demographics
NPI:1003846825
Name:DAVID PHYSICAL THERAPY AND SPORTS MEDICINE CENTER INC.
Entity Type:Organization
Organization Name:DAVID PHYSICAL THERAPY AND SPORTS MEDICINE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MS, PT,OCS,CSCS
Authorized Official - Phone:412-344-9044
Mailing Address - Street 1:433 CASTLE SHANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1405
Mailing Address - Country:US
Mailing Address - Phone:412-344-9044
Mailing Address - Fax:
Practice Address - Street 1:433 CASTLE SHANNON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1405
Practice Address - Country:US
Practice Address - Phone:412-344-9044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006491L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016074310001Medicaid
PA199055OtherBLUE SHIELD GRP NUMBER
PA199055OtherBLUE SHIELD GRP NUMBER