Provider Demographics
NPI:1972528024
Name:WEST SCHUYLKILL PHYSICAL THERAPY SERVICES, P.C.
Entity Type:Organization
Organization Name:WEST SCHUYLKILL PHYSICAL THERAPY SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PUTALAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-345-9966
Mailing Address - Street 1:8 OAK GROVE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963
Mailing Address - Country:US
Mailing Address - Phone:570-345-9966
Mailing Address - Fax:570-345-9988
Practice Address - Street 1:8 OAK GROVE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:PINE GROVE
Practice Address - State:PA
Practice Address - Zip Code:17963
Practice Address - Country:US
Practice Address - Phone:570-345-9966
Practice Address - Fax:570-345-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA720544OtherPENNSYLVANIA BLUE SHIELD
PA02858300OtherCAPITAL BLUE CROSS/CAIC
PA02858300OtherCAPITAL ADVANTAGE
PA033989OtherHIGHMARK MEDICARE SERVICES
PA033989OtherHIGHMARK MEDICARE SERVICES