Basic Information
Provider Information | |||||||||
NPI: | 1821180787 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GALVIN | ||||||||
FirstName: | LORI | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | P.T. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 520 PHILADELPHIA ST | ||||||||
Address2: |   | ||||||||
City: | INDIANA | ||||||||
State: | PA | ||||||||
PostalCode: | 157013902 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7244637478 | ||||||||
FaxNumber: | 7244630931 | ||||||||
Practice Location | |||||||||
Address1: | 333 HARVEY AVE | ||||||||
Address2: | SUITE 4 | ||||||||
City: | GREENSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 156011993 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7248373401 | ||||||||
FaxNumber: | 7248373439 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/29/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT011320L | PA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 7588745 | 01 | PA | AETNA | OTHER | 418892 | 01 | PA | HEALTH AMER/HEALTH ASSUR. | OTHER | GA1809784 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |