Provider Demographics
NPI:1720489511
Name:INTEGRATED FAMILY HEARING, LLC
Entity Type:Organization
Organization Name:INTEGRATED FAMILY HEARING, LLC
Other - Org Name:PETRUSO AUDIOLOGY OF COURDERSPORT, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:PETRUSO
Authorized Official - Suffix:II
Authorized Official - Credentials:AUD
Authorized Official - Phone:814-720-1692
Mailing Address - Street 1:536 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-9438
Mailing Address - Country:US
Mailing Address - Phone:814-274-9097
Mailing Address - Fax:814-274-0464
Practice Address - Street 1:536 E 2ND ST
Practice Address - Street 2:
Practice Address - City:COUDERSPORT
Practice Address - State:PA
Practice Address - Zip Code:16915-9438
Practice Address - Country:US
Practice Address - Phone:814-274-9097
Practice Address - Fax:814-274-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty