Provider Demographics
NPI:1427123660
Name:WESTERN PENNSYLVANIA SPORTS MEDICINE & REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:WESTERN PENNSYLVANIA SPORTS MEDICINE & REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-255-6814
Mailing Address - Street 1:927 MENOHER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2834
Mailing Address - Country:US
Mailing Address - Phone:814-255-6814
Mailing Address - Fax:814-255-7963
Practice Address - Street 1:927 MENOHER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2834
Practice Address - Country:US
Practice Address - Phone:814-255-6814
Practice Address - Fax:814-255-7963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
396652Medicare ID - Type Unspecified