Provider Demographics
NPI:1629009048
Name:CLINICAL THERAPEUTICS INC
Entity Type:Organization
Organization Name:CLINICAL THERAPEUTICS INC
Other - Org Name:CTI PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SANDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:814-726-9050
Mailing Address - Street 1:2265 MARKET STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4682
Mailing Address - Country:US
Mailing Address - Phone:814-726-9050
Mailing Address - Fax:814-726-9629
Practice Address - Street 1:2265 MARKET STREET
Practice Address - Street 2:SUITE A
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-4682
Practice Address - Country:US
Practice Address - Phone:814-726-9050
Practice Address - Fax:814-726-9629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007362470012Medicaid
PA577199Medicare PIN