Provider Demographics
NPI:1679692651
Name:OZAETA, EVELYN R (LPT)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:R
Last Name:OZAETA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 VALLEYVIEW DR.
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:PA
Mailing Address - Zip Code:15055-1035
Mailing Address - Country:US
Mailing Address - Phone:724-413-9657
Mailing Address - Fax:
Practice Address - Street 1:500 N LEWIS RUN RD
Practice Address - Street 2:SUITE 111
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-3056
Practice Address - Country:US
Practice Address - Phone:412-267-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009328L2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics