Provider Demographics
NPI:1508970252
Name:GREGORY R. PETROSKY
Entity Type:Organization
Organization Name:GREGORY R. PETROSKY
Other - Org Name:RIDGWAY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:REGIS
Authorized Official - Last Name:PETROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:814-772-7848
Mailing Address - Street 1:1 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-1817
Mailing Address - Country:US
Mailing Address - Phone:814-772-7848
Mailing Address - Fax:814-772-7849
Practice Address - Street 1:1 SOUTH ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-1817
Practice Address - Country:US
Practice Address - Phone:814-772-7848
Practice Address - Fax:814-772-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007531L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA15435100004OtherMEDICAL ASSISTANCE
PA279823OtherHIGHMARK
PA279823OtherHIGHMARK
PA15435100004OtherMEDICAL ASSISTANCE