Provider Demographics
NPI:1295769370
Name:SPRAGUE PHYSICAL THERAPY CENTER, INC
Entity type:Organization
Organization Name:SPRAGUE PHYSICAL THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DAVIESS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:412-481-1188
Mailing Address - Street 1:734 E WARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15210-1565
Mailing Address - Country:US
Mailing Address - Phone:412-481-1188
Mailing Address - Fax:
Practice Address - Street 1:734 E WARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15210-1565
Practice Address - Country:US
Practice Address - Phone:412-481-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000155119OtherUNISON HEALTH PLAN
PA1011184290001Medicaid
PA396586Medicare ID - Type Unspecified