Provider Demographics
NPI:1558383273
Name:PIZZELLA, KATHY ROTH (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:ROTH
Last Name:PIZZELLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:E
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:609 ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-2003
Mailing Address - Country:US
Mailing Address - Phone:412-828-0700
Mailing Address - Fax:412-828-9140
Practice Address - Street 1:609 ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-2003
Practice Address - Country:US
Practice Address - Phone:412-828-0700
Practice Address - Fax:412-828-9140
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007623-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAJ-007623-LOtherADJUNCTIVE PROCEDURES LIC
PA497189OtherBC/BS PROVIDER #
PADC-007623-LOtherCHIROPRACTIC LICENSE #