Provider Demographics
NPI:1265410153
Name:SPELLANE, VINCENT JOSEPH (DPT,CSCS,CWT,BS,AS)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:SPELLANE
Suffix:
Gender:M
Credentials:DPT,CSCS,CWT,BS,AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 STEELE RD
Mailing Address - Street 2:
Mailing Address - City:SALTSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15681-4241
Mailing Address - Country:US
Mailing Address - Phone:724-972-7137
Mailing Address - Fax:
Practice Address - Street 1:1176 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-4514
Practice Address - Country:US
Practice Address - Phone:724-357-9991
Practice Address - Fax:724-357-9993
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1748120OtherHIGHMARK BC BS
093064Medicare ID - Type Unspecified
PA1748120OtherHIGHMARK BC BS