Provider Demographics
NPI:1629564471
Name:WONSETTLER PHYSICAL THERAPY AND SPECIALIZED HEALTH
Entity Type:Organization
Organization Name:WONSETTLER PHYSICAL THERAPY AND SPECIALIZED HEALTH
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WONSETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, CSCS
Authorized Official - Phone:724-288-4990
Mailing Address - Street 1:47 WONSETTLER RD
Mailing Address - Street 2:
Mailing Address - City:SCENERY HILL
Mailing Address - State:PA
Mailing Address - Zip Code:15360-1831
Mailing Address - Country:US
Mailing Address - Phone:724-288-4990
Mailing Address - Fax:
Practice Address - Street 1:100 WONSETTLER RD
Practice Address - Street 2:
Practice Address - City:SCENERY HILL
Practice Address - State:PA
Practice Address - Zip Code:15360-1863
Practice Address - Country:US
Practice Address - Phone:724-288-4990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019921261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy