Provider Demographics
NPI:1275824286
Name:CONNEAUT PHYSICAL THERAPY, L.L.C.
Entity Type:Organization
Organization Name:CONNEAUT PHYSICAL THERAPY, L.L.C.
Other - Org Name:RANDALL B. SCHLOSSER, P.T.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING AND CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-783-0051
Mailing Address - Street 1:11018 STATE HWY 18
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CONNEAUT LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16316-3556
Mailing Address - Country:US
Mailing Address - Phone:814-382-6570
Mailing Address - Fax:814-382-6569
Practice Address - Street 1:11018 STATE HWY 18
Practice Address - Street 2:SUITE 3
Practice Address - City:CONNEAUT LAKE
Practice Address - State:PA
Practice Address - Zip Code:16316-3556
Practice Address - Country:US
Practice Address - Phone:814-382-6570
Practice Address - Fax:814-382-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-006582-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA696729Medicare PIN