1306153770 NPI number — SHARON LYNN PACHECO PHYSICAL THERAPIST

Table of content: SHARON LYNN PACHECO PHYSICAL THERAPIST (NPI 1306153770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306153770 NPI number — SHARON LYNN PACHECO PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACHECO
Provider First Name:
SHARON
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306153770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 PHILADELPHIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15701-3902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-463-7478
Provider Business Mailing Address Fax Number:
724-463-0931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 UNION AVENUE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
NATRONA HEIGHTS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15065-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-224-5090
Provider Business Practice Location Address Fax Number:
724-224-5093
Provider Enumeration Date:
09/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT008088L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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