Basic Information
| Provider Information | |||||||||
| NPI: | 1699038943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUCHETTI | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 NATURE PARK RD | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156016960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246890571 | ||||||||
| FaxNumber: | 7246890560 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 NATURE PARK RD | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156016960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246890571 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2012 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 013613 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 103765636 | 05 | PA | MEDICAID |