Provider Demographics
NPI:1407830920
Name:WEST PENN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WEST PENN PHYSICAL THERAPY
Other - Org Name:LAUREL HIGHLANDS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:IMBROGNO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-537-9577
Mailing Address - Street 1:911 LIGONIER ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1805
Mailing Address - Country:US
Mailing Address - Phone:724-537-9577
Mailing Address - Fax:724-537-0195
Practice Address - Street 1:911 LIGONIER ST
Practice Address - Street 2:SUITE 001
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1805
Practice Address - Country:US
Practice Address - Phone:724-537-9577
Practice Address - Fax:724-537-0195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396560Medicare ID - Type Unspecified