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Organization
NORTHWESTERN PHYSICAL THERAPY SERVICE, INC.
Active
Organization
NORTHWESTERN PHYSICAL THERAPY SERVICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY D CLARK PT (PRESIDENT)
(814) 827-2347
Entity
Organization
Contact information
Practice address
202 UNION ST, TITUSVILLE, PA 16354-1160
(814) 827-2347
(814) 827-2391
Mailing address
202 UNION ST, P O BOX 381, TITUSVILLE, PA 16354-1160
(814) 827-2347
(814) 827-2391
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014374730005
—
PA
01
—
NO412827
HIGHMARK BC/BS I.D.
PA
Enumeration date
06/12/2006
Last updated
03/30/2011
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