Provider Demographics
NPI:1770980724
Name:ORTHOPEDIC AND SPORTS PHYSICAL THERAPY ASSOCIATES
Entity type:Organization
Organization Name:ORTHOPEDIC AND SPORTS PHYSICAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST /OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-483-2159
Mailing Address - Street 1:160 GREENE PLZ
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8142
Mailing Address - Country:US
Mailing Address - Phone:724-852-2504
Mailing Address - Fax:724-852-2547
Practice Address - Street 1:160 GREENE PLZ
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8142
Practice Address - Country:US
Practice Address - Phone:724-852-2504
Practice Address - Fax:724-852-2547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty