Healthcare Provider Details

I. General information

NPI: 1275437170
Provider Name (Legal Business Name): CAROLINE FACKLER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 E CHOCOLATE AVE STE 100
HERSHEY PA
17033-1201
US

IV. Provider business mailing address

PO BOX 39292573
PITTSBURGH PA
15251-9573
US

V. Phone/Fax

Practice location:
  • Phone: 223-308-9450
  • Fax:
Mailing address:
  • Phone: 724-343-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: