Provider Demographics
NPI:1972501757
Name:MAHONING PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MAHONING PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-254-1010
Mailing Address - Street 1:405 FRANKLIN ST
Mailing Address - Street 2:P O BOX 153
Mailing Address - City:CLYMER
Mailing Address - State:PA
Mailing Address - Zip Code:15728-1174
Mailing Address - Country:US
Mailing Address - Phone:724-254-1010
Mailing Address - Fax:
Practice Address - Street 1:405 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CLYMER
Practice Address - State:PA
Practice Address - Zip Code:15728-1174
Practice Address - Country:US
Practice Address - Phone:724-254-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000800E2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
396616Medicare ID - Type Unspecified