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Allstar Therapies, Inc.
The Therapy You Need, The Results You Deserve.
(724) 327-3553
2030 Ader Rd, Penn Township, PA 15644
2030 Ader RdPenn Township PA 15644
(724) 327-3553
Contact Us Today!
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Home
Services
Services
Care Settings
Skilled Nursing
Home Care
Assisted Living
Correctional Care
Clinical Services
Physical Therapy
Occupational Therapy
Speech Therapy
About Us
About Us
Our Team
Core 4 Pathways
Testimonials
Resources
Referral for Therapy
Patient Driven Payment Model
Patient Driven Grouping Model
Education
Allstar Newsletter
Home Care Coverage
Careers
Contact
All @ Home
Referral for Therapy
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Referral for Therapy
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Name
*
First
Last
Date of Birth
*
Address
*
Address Line 1
Address Line 2
*
Address Line 2
City, State, ZIP
Address Line 3
Phone Number
*
Primary Phone #
Phone Number Secondary
Secondary Phone #
Email
Insurance
*
Primary Insurance
Insurance - Secondary
Secondary Insurance
Primary Caregiver
*
Primary Caregiver's Name
Primary Caregiver - Relationship
Primary Caregiver's Relationship
Primary Caregiver - Phone
Primary Caregiver's Phone #
Doctor
*
Doctor's Name
Doctor - NPI#
Doctor's NPI #
Doctor - Phone
*
Doctor's Phone #
Doctor - Fax
Doctor's Fax #
Referral for Therapy
*
Physical Therapy
Occupational Therapy
Speech Therapy
Primary Diagnosis
*
Secondary Diagnosis
Treatments
Eval and Treat
Moist Heat
Ultrasound
Electrical Stimulation
T.E.N.S.
Cryotherapy
Orthotic Devices / DME
Mobilization / Manual Therapy
Gait Training
Neuromuscular Reeducation
ADLS / IADL's
Therapeutic Exercise
Core Strengthening
Massage / Soft Tissue Mobilization
Comments, Instructions, Precautions
Frequency
Next Md Visit
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