Basic Information
| Provider Information | |||||||||
| NPI: | 1578996716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GDULA | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 932 JEFFERSON AVE. | ||||||||
| Address2: | |||||||||
| City: | BEAVERDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159210077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142428090 | ||||||||
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| Practice Location | |||||||||
| Address1: | 108 FRANCISCAN WAY | ||||||||
| Address2: | |||||||||
| City: | LORETTO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159409703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144723936 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2013 | ||||||||
| LastUpdateDate: | 08/12/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT023000 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.