Provider Demographics
NPI:1366964561
Name:CANCELMI, JEFFREY JOHN (ATC, DPT, PT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:CANCELMI
Suffix:
Gender:M
Credentials:ATC, DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-1639
Mailing Address - Country:US
Mailing Address - Phone:412-508-1200
Mailing Address - Fax:
Practice Address - Street 1:2080 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5229
Practice Address - Country:US
Practice Address - Phone:304-905-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT003817208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation