Organization
CCMH PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD PITCHFORD (CEO)
(814) 274-5216
Entity
Organization
Contact information
Practice address
1001 EAST SECOND STREET, COUDERSPORT, PA 16915
(814) 274-9300
Mailing address
1001 EAST SECOND STREET, COUDERSPORT, PA 16915
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1636325
BLUE SHIELD
PA
Enumeration date
03/11/2008
Last updated
03/11/2008
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