Provider Demographics
NPI:1043335391
Name:MASTERS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MASTERS PHYSICAL THERAPY, INC.
Other - Org Name:MASTERS PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STYBORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:814-663-7878
Mailing Address - Street 1:407 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1203
Mailing Address - Country:US
Mailing Address - Phone:814-663-7878
Mailing Address - Fax:814-663-0661
Practice Address - Street 1:407 N CENTER ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1203
Practice Address - Country:US
Practice Address - Phone:814-663-7878
Practice Address - Fax:814-663-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1443604OtherBS GROUP
PA562309419OtherCOMMERCIAL
PA1443604OtherBS GROUP