Provider Demographics
NPI:1598707838
Name:PHYSICAL THERAPY SERVICES OF ERIE, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF ERIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:LABROZZI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:814-397-6872
Mailing Address - Street 1:PO BOX 9897
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505
Mailing Address - Country:US
Mailing Address - Phone:814-397-6872
Mailing Address - Fax:814-835-0302
Practice Address - Street 1:2374 VILLAGE COMMON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-7201
Practice Address - Country:US
Practice Address - Phone:814-835-0300
Practice Address - Fax:814-835-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006529L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019443950003Medicaid
PA1302096OtherPA BLUE SHIELD
PAP03409Medicare UPIN
PAP00097514Medicare ID - Type UnspecifiedRAILROAD MEDICARE
PA067234Medicare ID - Type Unspecified