Provider Demographics
NPI:1336216332
Name:FORMAINI, DAMON ANTHONY (MPT)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:ANTHONY
Last Name:FORMAINI
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:5 FRANKLIN VILLAGE MALL
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-8803
Practice Address - Country:US
Practice Address - Phone:724-543-6452
Practice Address - Fax:724-543-5617
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010972L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA457005OtherHEALTH AMERICA-ASSURANCE
PA232918467OtherAETNA
PAFO1908605OtherHIGHMARK BLUE SHIELD
PAFO1908605OtherHIGHMARK BLUE SHIELD