Provider Demographics
NPI:1548261639
Name:LURTY, WILLIAM JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOHN
Last Name:LURTY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201B ERIE ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1610
Mailing Address - Country:US
Mailing Address - Phone:724-458-5850
Mailing Address - Fax:724-458-4402
Practice Address - Street 1:201B ERIE ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1610
Practice Address - Country:US
Practice Address - Phone:724-458-5850
Practice Address - Fax:724-458-4402
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001451L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALU122280OtherBLUE CROSS BLUE SHIELD
PA023820M9GMedicare ID - Type Unspecified