Provider Demographics
NPI:1962942268
Name:ARTISTIC ATHLETICS PHYSICAL THERAPY AND PERFORMANCE
Entity type:Organization
Organization Name:ARTISTIC ATHLETICS PHYSICAL THERAPY AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TALIA
Authorized Official - Middle Name:TRAPUZZANO
Authorized Official - Last Name:EUBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, SCS, ATC
Authorized Official - Phone:412-303-9957
Mailing Address - Street 1:1401 CORAOPOLIS HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:994 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:MOON TWP
Practice Address - State:PA
Practice Address - Zip Code:15108-2347
Practice Address - Country:US
Practice Address - Phone:412-303-9957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA012896261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy