Provider Demographics
NPI:1760698302
Name:CHERRY TREE MEDICAL ASSOCIATES PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CHERRY TREE MEDICAL ASSOCIATES PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MASNERI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-438-1810
Mailing Address - Street 1:20 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8922
Mailing Address - Country:US
Mailing Address - Phone:724-438-1810
Mailing Address - Fax:724-438-2011
Practice Address - Street 1:20 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8922
Practice Address - Country:US
Practice Address - Phone:724-438-1810
Practice Address - Fax:724-438-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008488L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017050000006Medicaid