Provider Demographics
NPI:1407073455
Name:FATULA, GEORGE M JR (DPT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:M
Last Name:FATULA
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 DON ST
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3448
Mailing Address - Country:US
Mailing Address - Phone:814-375-8799
Mailing Address - Fax:814-375-3049
Practice Address - Street 1:127 N BRADY ST
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2227
Practice Address - Country:US
Practice Address - Phone:814-375-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009793L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist