Provider Demographics
NPI:1699737668
Name:RECTENWALD, MARY G (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:G
Last Name:RECTENWALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:G
Other - Last Name:LAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:438 PELLIS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-7900
Mailing Address - Country:US
Mailing Address - Phone:724-850-7587
Mailing Address - Fax:724-850-9909
Practice Address - Street 1:555 ROUTE 217
Practice Address - Street 2:SUITE 3
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-3484
Practice Address - Country:US
Practice Address - Phone:724-694-5737
Practice Address - Fax:724-694-6022
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009319L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016022270006Medicaid
PA035672Medicare ID - Type Unspecified
PA0016022270006Medicaid