Basic Information
| Provider Information | |||||||||
| NPI: | 1275867087 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARK | ||||||||
| FirstName: | BETSY | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 249 MAUS DR | ||||||||
| Address2: | |||||||||
| City: | NORTH HUNTINGDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156422057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248639118 | ||||||||
| FaxNumber: | 7248638334 | ||||||||
| Practice Location | |||||||||
| Address1: | 249 MAUS DR | ||||||||
| Address2: | |||||||||
| City: | NORTH HUNTINGDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156422057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248639118 | ||||||||
| FaxNumber: | 7248638334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2009 | ||||||||
| LastUpdateDate: | 09/25/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT013820L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.