Provider Demographics
NPI:1659510287
Name:ZELCH, LARA BETH (MPT)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:BETH
Last Name:ZELCH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:BETH
Other - Last Name:BERTUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1807 MERCER ROAD
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16157
Mailing Address - Country:US
Mailing Address - Phone:724-758-3338
Mailing Address - Fax:724-752-8878
Practice Address - Street 1:1807 MERCER RD.
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16157
Practice Address - Country:US
Practice Address - Phone:724-758-3338
Practice Address - Fax:724-752-8878
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008233L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001379515OtherHIGHMARK
PAP63900Medicare UPIN
PA059754QSSMedicare PIN