Provider Demographics
NPI:1245408442
Name:CHERRY TREE MEDICAL ASSOC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CHERRY TREE MEDICAL ASSOC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEAZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-439-4531
Mailing Address - Street 1:20 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8922
Mailing Address - Country:US
Mailing Address - Phone:724-438-1810
Mailing Address - Fax:724-438-2011
Practice Address - Street 1:20 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8922
Practice Address - Country:US
Practice Address - Phone:724-438-1810
Practice Address - Fax:724-438-2011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHERRY TREE MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1913125261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1913125OtherHIGHMARK