1679574859 NPI number — CENTRAL MOUNTAIN PHYSICAL THERAPY INC

Table of content: (NPI 1679574859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679574859 NPI number — CENTRAL MOUNTAIN PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL MOUNTAIN PHYSICAL THERAPY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679574859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
685 ISLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOCK HAVEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17745-8844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-748-2678
Provider Business Mailing Address Fax Number:
570-748-4015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
685 ISLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745-8844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-748-2678
Provider Business Practice Location Address Fax Number:
570-748-4015
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DINGES
Authorized Official First Name:
LORI
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER/PT
Authorized Official Telephone Number:
570-748-2678

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  PT007705L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: PT007553L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: PT009179L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001888394 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 347875600 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 928954 . This is a "BC/BS-GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 63410 9969 . This is a "GEISINGER-GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 140512 . This is a "HEALTH AMERICA-GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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