1114989993 NPI number — ABLE THERAPY SERVICES, INC

Table of content: (NPI 1114989993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114989993 NPI number — ABLE THERAPY SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABLE THERAPY SERVICES, 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:
1114989993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2605 REACH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17701-4181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-322-2251
Provider Business Mailing Address Fax Number:
570-321-9504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2605 REACH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17701-4181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-322-2251
Provider Business Practice Location Address Fax Number:
570-321-9504
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAKOWSKI
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
WHITNEY
Authorized Official Title or Position:
PRESIDENT / OWNER
Authorized Official Telephone Number:
570-322-2251

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DD1893 . This is a "MEDICARE RAILROAD PROV #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50049988 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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