Provider Demographics
NPI:1548459167
Name:SENGEWALT, STACI (PT)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:SENGEWALT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WILDFLOWER CIR
Mailing Address - Street 2:STE 903
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9782
Mailing Address - Country:US
Mailing Address - Phone:724-416-7172
Mailing Address - Fax:724-416-3037
Practice Address - Street 1:1086 E BETHLEHEM BLVD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-4961
Practice Address - Country:US
Practice Address - Phone:304-238-9468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist