Provider Demographics
NPI:1104188614
Name:GANASSI, DOUGLAS PAUL (MED - EX SCI, ATC,)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:GANASSI
Suffix:
Gender:M
Credentials:MED - EX SCI, ATC,
Other - Prefix:
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Mailing Address - Street 1:800 ALLEGHENY AVENUE
Mailing Address - Street 2:CCAC
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15233-1895
Mailing Address - Country:US
Mailing Address - Phone:412-237-3121
Mailing Address - Fax:412-237-3135
Practice Address - Street 1:1750 CLAIRTON ROAD, ROUTE 885
Practice Address - Street 2:CCAC - SOUTH CAMPUS
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-3097
Practice Address - Country:US
Practice Address - Phone:412-469-1100
Practice Address - Fax:412-469-6254
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2013-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PART002222A2255A2300X
GAAT0003692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer