Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | OS016173 | PA |
Y | 213ES0000X | Sports Medicine | OS016173 | PA |
NPI | 1447419981 |
---|---|
Provider Name | Dr. Jesse Sally |
First Address | Pittsburgh, PA 15238-2917 |
Second Address | Pittsburgh, PA 15238-2917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 01/05/2015 |