Provider Demographics
NPI:1093361610
Name:STAWECKI PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:STAWECKI PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STAWECKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-504-6536
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:PA
Mailing Address - Zip Code:16059-0597
Mailing Address - Country:US
Mailing Address - Phone:724-931-3646
Mailing Address - Fax:
Practice Address - Street 1:207 NORTH TRL
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16002-7609
Practice Address - Country:US
Practice Address - Phone:724-504-6536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty