Provider Demographics
NPI:1093763468
Name:ATHLON PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:ATHLON PHYSICAL THERAPY, INC
Other - Org Name:GREATER PITTSBURGH PHYSICAL THERAPY AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENI
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-816-0567
Mailing Address - Street 1:725 CHERRINGTON PARKWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4305
Mailing Address - Country:US
Mailing Address - Phone:412-264-6192
Mailing Address - Fax:412-264-6196
Practice Address - Street 1:725 CHERRINGTON PARKWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-4305
Practice Address - Country:US
Practice Address - Phone:412-264-6192
Practice Address - Fax:412-264-6196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA069901Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION