Healthcare Provider Details

I. General information

NPI: 1497536734
Provider Name (Legal Business Name): CELESTE PORTIGIANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FOWLER AVE
BERWICK PA
18603-2300
US

IV. Provider business mailing address

114 LOWER MULBERRY ST APT 201
DANVILLE PA
17821-1586
US

V. Phone/Fax

Practice location:
  • Phone: 570-759-6400
  • Fax:
Mailing address:
  • Phone: 631-559-9291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT008687
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: