Provider Demographics
NPI:1881650281
Name:PETRICK, STANLEY T (MSPT)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:T
Last Name:PETRICK
Suffix:
Gender:
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WESTINGHOUSE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5238
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:
Practice Address - Street 1:1201B N CHURCH ST STE 308
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-1454
Practice Address - Country:US
Practice Address - Phone:570-455-7108
Practice Address - Fax:570-455-8835
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011725L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1230503OtherFIRST HEALTH
P00199564OtherRAILROAD MEDICARE
PAPE176517OtherBLUE SHIELD
PA820635OtherFIRST PRIORITY
230232OtherHEALTH AMERICA
PA50038360OtherCAPITAL BLUE CROSS
1230503OtherFIRST HEALTH