Basic Information
| Provider Information | |||||||||
| NPI: | 1780631077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BATTAGLINI | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1265 WAYNE AVE STE 308 | ||||||||
| Address2: | 119 PROFESSINAL BUILDING | ||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157013501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248018095 | ||||||||
| FaxNumber: | 7248018147 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 STATE RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190631452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108927344 | ||||||||
| FaxNumber: | 6105650500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J1-0001501 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 25733 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT013499L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2844946000 | 01 | DE | IBC | OTHER | AC44-0023 | 01 | DE | CAREFIRST | OTHER | 0962113000 | 01 | PA | IBC | OTHER | 3211151 | 05 | MD | MEDICAID | 1300966 | 01 | HIGHMARK PABS | OTHER | 1780631077 | 05 | DE | MEDICAID | 50108718 | 01 | PA | CAPITAL BC | OTHER | 1780631077 | 01 | PA | BRAVO | OTHER | 001874791 | 05 | PA | MEDICAID | 058152VLZ | 01 | PA | MEDICARE | OTHER | P00713330 | 01 | DE | RAILROAD MEDICARE | OTHER | P00713327 | 01 | PA | RAILROAD MEDICARE | OTHER |