Provider Demographics
NPI:1407072473
Name:FAMILY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FAMILY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:WOZNEAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:814-726-3574
Mailing Address - Street 1:BOX 424
Mailing Address - Street 2:218 LIBERTY ST
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365
Mailing Address - Country:US
Mailing Address - Phone:814-726-3574
Mailing Address - Fax:814-726-3583
Practice Address - Street 1:218 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365
Practice Address - Country:US
Practice Address - Phone:814-726-3574
Practice Address - Fax:814-726-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005465L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAFA573459OtherASSIGNMENT
PAW0678838OtherBC
PAW0678838Medicare ID - Type Unspecified