Provider Demographics
NPI:1154714723
Name:CENTER FOR MYOFASCIAL THERAPY
Entity type:Organization
Organization Name:CENTER FOR MYOFASCIAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER; PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:SPANOS
Authorized Official - Suffix:
Authorized Official - Credentials:CMTPT; LMT
Authorized Official - Phone:412-431-9180
Mailing Address - Street 1:617 LOUGEAY RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4508
Mailing Address - Country:US
Mailing Address - Phone:412-431-9180
Mailing Address - Fax:412-381-6922
Practice Address - Street 1:1312 E CARSON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1510
Practice Address - Country:US
Practice Address - Phone:412-431-9180
Practice Address - Fax:412-381-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003481174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty