Healthcare Provider Details

I. General information

NPI: 1427079862
Provider Name (Legal Business Name): SUSAN ANN ROVINSKY P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 MAIN ST
DICKSON CITY PA
18519-1620
US

IV. Provider business mailing address

RR 2 BOX 178
OLYPHANT PA
18447-9623
US

V. Phone/Fax

Practice location:
  • Phone: 570-307-1769
  • Fax: 570-307-1771
Mailing address:
  • Phone: 570-254-6561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberTE002480L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: