Provider Demographics
NPI:1285618082
Name:BERTINI, ANTHONY B (PT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
Last Name:BERTINI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1383 BUCKTAIL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3266
Mailing Address - Country:US
Mailing Address - Phone:814-834-0059
Mailing Address - Fax:814-834-0060
Practice Address - Street 1:1383 BUCKTAIL RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3266
Practice Address - Country:US
Practice Address - Phone:814-834-0059
Practice Address - Fax:814-834-0060
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2009-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003005L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025541Medicaid
PA748694Medicare ID - Type Unspecified
PA0791640001Medicare NSC