Individual
MR. MICHAEL CIVITELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
812 BROAD AVE, BELLE VERNON, PA 15012-1664
(724) 929-5774
(724) 929-9524
Mailing address
812 BROAD AVE, BELLE VERNON, PA 15012-1664
(724) 929-5774
(724) 929-9524
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT010031L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015935850006
—
PA
Enumeration date
06/28/2006
Last updated
07/09/2007
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