Provider Demographics
NPI:1346303302
Name:WEST END PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:WEST END PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAZICKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:610-681-3627
Mailing Address - Street 1:RT 209 PO BOX 1020
Mailing Address - Street 2:WEST END PHYSICAL THERAPY INC
Mailing Address - City:KRESGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:18333
Mailing Address - Country:US
Mailing Address - Phone:610-681-3637
Mailing Address - Fax:610-681-6344
Practice Address - Street 1:ROUTE 209
Practice Address - Street 2:
Practice Address - City:KRESEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:18333
Practice Address - Country:US
Practice Address - Phone:610-681-3637
Practice Address - Fax:610-681-6344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
070737Medicare ID - Type Unspecified