Healthcare Provider Details

I. General information

NPI: 1790792109
Provider Name (Legal Business Name): JEFFREY PLATEK MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
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: 570-455-5331
Mailing address:
  • Phone: 570-453-0252
  • Fax: 570-455-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier817794
Identifier TypeOTHER
Identifier State
Identifier IssuerFIRST PRIORITY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: