Provider Demographics
NPI:1669409777
Name:ST. CLAIR, EDWARD A (PT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:ST. CLAIR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 PONE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-3553
Mailing Address - Country:US
Mailing Address - Phone:814-437-6191
Mailing Address - Fax:814-437-6197
Practice Address - Street 1:571 PONE LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-3553
Practice Address - Country:US
Practice Address - Phone:724-458-5850
Practice Address - Fax:724-458-4402
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012340L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA017834720001Medicaid
PA000782859OtherHIGHMARK
PA000782859OtherHIGHMARK
PA033901M9GMedicare ID - Type Unspecified