Healthcare Provider Details

I. General information

NPI: 1811920739
Provider Name (Legal Business Name): SARAH N SERATCH MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH N BUCZKOWSKI MPT

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/28/2009
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 NumberDAPT000041
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier2484107
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 2
Identifier624329
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 3
Identifier50016510
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS
# 4
Identifier018933760001-0002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: