Provider Demographics
NPI:1194255786
Name:ROSCOE PHYSIOTHERAPY CO
Entity type:Organization
Organization Name:ROSCOE PHYSIOTHERAPY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSCOE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:724-813-0933
Mailing Address - Street 1:28 HOGUE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST MIDDLESEX
Mailing Address - State:PA
Mailing Address - Zip Code:16159-2512
Mailing Address - Country:US
Mailing Address - Phone:724-813-0933
Mailing Address - Fax:
Practice Address - Street 1:100 N KEEL RIDGE RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3440
Practice Address - Country:US
Practice Address - Phone:724-813-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021467261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy