Provider Demographics
NPI:1275596900
Name:KLUG, JEFF (PT)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:KLUG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ADLIN AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:PA
Mailing Address - Zip Code:15342-1001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2414 LYTLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2736
Practice Address - Country:US
Practice Address - Phone:412-854-5077
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011624L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist