Healthcare Provider Details

I. General information

NPI: 1205374642
Provider Name (Legal Business Name): CHARLES ERNEY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 EARLYSTOWN RD
CENTRE HALL PA
16828-9108
US

IV. Provider business mailing address

310 PENN ST STE 103
HOLLIDAYSBURG PA
16648-2044
US

V. Phone/Fax

Practice location:
  • Phone: 814-364-3290
  • Fax: 814-364-3295
Mailing address:
  • Phone: 814-364-3290
  • Fax: 814-364-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003789
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT025835
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: