Provider Demographics
NPI:1710583422
Name:GREAT TITAN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:GREAT TITAN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PTA
Authorized Official - Phone:412-452-2088
Mailing Address - Street 1:2053 LEY ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-3218
Mailing Address - Country:US
Mailing Address - Phone:412-452-2088
Mailing Address - Fax:
Practice Address - Street 1:2053 LEY ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-3218
Practice Address - Country:US
Practice Address - Phone:412-452-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT TITAN INDUSTRIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy