Healthcare Provider Details

I. General information

NPI: 1598800385
Provider Name (Legal Business Name): PINDAR PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W TAMARACK ST
HAZLETON PA
18201-5876
US

IV. Provider business mailing address

221 W TAMARACK ST
HAZLETON PA
18201-5876
US

V. Phone/Fax

Practice location:
  • Phone: 570-401-6566
  • Fax: 570-501-2438
Mailing address:
  • Phone: 570-401-6566
  • Fax: 570-501-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006560L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier104972960001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
IdentifierDC4142
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name: GEORGINE PINDAR
Title or Position: PRESIDENT
Credential: DPT
Phone: 570-401-6566