Provider Demographics
NPI:1093742462
Name:PHYSICAL, REHABILITATION, INDUSTRIAL AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:PHYSICAL, REHABILITATION, INDUSTRIAL AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-941-3388
Mailing Address - Street 1:2005 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4548
Mailing Address - Country:US
Mailing Address - Phone:814-941-3388
Mailing Address - Fax:814-941-3279
Practice Address - Street 1:2005 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4548
Practice Address - Country:US
Practice Address - Phone:814-941-3388
Practice Address - Fax:814-941-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009586L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001708155Medicaid
PA001708155Medicaid