Provider Demographics
NPI:1083853329
Name:DISEPIO INSTITUTE FOR RURAL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:DISEPIO INSTITUTE FOR RURAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:ARNALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS, MBA
Authorized Official - Phone:814-472-3199
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:108 FRANCISCAN WAY
Mailing Address - City:LORETTO
Mailing Address - State:PA
Mailing Address - Zip Code:15940-0600
Mailing Address - Country:US
Mailing Address - Phone:814-472-3199
Mailing Address - Fax:814-472-3140
Practice Address - Street 1:108 FRANCISCAN WAY
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:PA
Practice Address - Zip Code:15940-0600
Practice Address - Country:US
Practice Address - Phone:814-472-3936
Practice Address - Fax:814-472-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225X00000X, 261QP2000X, 363AM0700X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty