Healthcare Provider Details

I. General information

NPI: 1730116096
Provider Name (Legal Business Name): FRANK SERATCH III MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
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

1076 VALLEY OF LKS
HAZLETON PA
18202-9385
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-4559
  • Fax: 570-459-4558
Mailing address:
  • Phone: 570-384-1162
  • Fax: 570-384-1163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberDAPT000042
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier743930
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 2
Identifier2482564
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 3
Identifier018933580002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 4
Identifier50016498
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: