Healthcare Provider Details

I. General information

NPI: 1023011186
Provider Name (Legal Business Name): SOSAR PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 S GARFIELD AVE
FRACKVILLE PA
17931-2427
US

IV. Provider business mailing address

649 S GARFIELD AVE
FRACKVILLE PA
17931-2427
US

V. Phone/Fax

Practice location:
  • Phone: 570-874-2125
  • Fax: 570-874-4019
Mailing address:
  • Phone: 570-874-2125
  • Fax: 570-874-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: REGINA A. CONSTANTINE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 570-874-2125