Provider Demographics
NPI:1346567161
Name:SOVITSKI, MARYDELLE LEILA LEGASPI (PT)
Entity Type:Individual
Prefix:
First Name:MARYDELLE LEILA
Middle Name:LEGASPI
Last Name:SOVITSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARYDELLE LEILA
Other - Middle Name:TACBOBO
Other - Last Name:LEGASPI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:931 FREEPORT RD APT B
Mailing Address - Street 2:
Mailing Address - City:CREIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:15030-1081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1810
Practice Address - Country:US
Practice Address - Phone:724-493-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031130225100000X
PAPT029209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist