Provider Demographics
NPI:1598732034
Name:EBERLES PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:EBERLES PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-734-7444
Mailing Address - Street 1:103 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-2237
Mailing Address - Country:US
Mailing Address - Phone:814-734-7444
Mailing Address - Fax:814-734-8509
Practice Address - Street 1:103 WALKER DR
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-2237
Practice Address - Country:US
Practice Address - Phone:814-734-7444
Practice Address - Fax:814-734-8509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019629100001Medicaid
PA071292Medicare ID - Type Unspecified
PA0019629100001Medicaid