Provider Demographics
NPI:1750715967
Name:BANDURAK, DOUGLAS (DPT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:BANDURAK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GREENSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:PA
Mailing Address - Zip Code:15089-2060
Mailing Address - Country:US
Mailing Address - Phone:724-872-0356
Mailing Address - Fax:724-872-6051
Practice Address - Street 1:300 GREENSBURG PIKE
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:PA
Practice Address - Zip Code:15089-2060
Practice Address - Country:US
Practice Address - Phone:724-872-0356
Practice Address - Fax:724-872-6051
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist