Provider Demographics
NPI:1568423242
Name:LIGONIER PHYSICAL THERAPY CLINIC INC
Entity Type:Organization
Organization Name:LIGONIER PHYSICAL THERAPY CLINIC INC
Other - Org Name:LIGONIER PHYSICAL AND OCCUPATIONAL THERAPY CLINIC INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:ETHLYN
Authorized Official - Last Name:PEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:724-238-3301
Mailing Address - Street 1:174 BARRON ROAD
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658
Mailing Address - Country:US
Mailing Address - Phone:724-238-3301
Mailing Address - Fax:724-238-3011
Practice Address - Street 1:352 RAILROAD STREET
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658
Practice Address - Country:US
Practice Address - Phone:724-238-6660
Practice Address - Fax:724-238-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25379Medicare ID - Type Unspecified