Healthcare Provider Details

I. General information

NPI: 1235188624
Provider Name (Legal Business Name): MODERN THERAPEUTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 W 15TH ST
HAZLETON PA
18201
US

IV. Provider business mailing address

1109 W 15TH ST
HAZLETON PA
18201
US

V. Phone/Fax

Practice location:
  • Phone: 570-453-0252
  • Fax: 570-453-0253
Mailing address:
  • Phone: 570-453-0252
  • Fax: 570-453-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ANTHONY PHILLIP URILLO
Title or Position: PRESIDENT
Credential: MPT
Phone: 570-453-0252