Healthcare Provider Details

I. General information

NPI: 1023010667
Provider Name (Legal Business Name): NORTHEAST PT ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 E BROAD ST
HAZLETON PA
18201-5650
US

IV. Provider business mailing address

1751 E BROAD ST
HAZLETON PA
18201-5650
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-4559
  • Fax: 570-459-4558
Mailing address:
  • Phone: 570-459-4559
  • Fax: 570-459-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberDAPT000042
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. FRANK SERATCH III
Title or Position: SECRETARY-TREASURER
Credential: MPT
Phone: 570-459-4559