Provider Demographics
NPI:1568521987
Name:BURGETTSTOWN PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BURGETTSTOWN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CHRISTOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:412-670-4435
Mailing Address - Street 1:470 JOHNSON RD STE 140
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8977
Mailing Address - Country:US
Mailing Address - Phone:724-223-2061
Mailing Address - Fax:724-223-2064
Practice Address - Street 1:2038 SMITH TOWNSHIP STATE ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:BURGETTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15021
Practice Address - Country:US
Practice Address - Phone:724-947-1002
Practice Address - Fax:724-947-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT014083L225100000X
PAPT007454L225100000X
PAPT015245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018763840004Medicaid
057929Medicare PIN