Provider Demographics
NPI:1952061533
Name:CONGLOSE, JOHN CHARLES
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:CONGLOSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-4803
Mailing Address - Country:US
Mailing Address - Phone:724-714-5702
Mailing Address - Fax:
Practice Address - Street 1:2550 MOSSIDE BLVD STE 415
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3533
Practice Address - Country:US
Practice Address - Phone:412-457-1109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist