Healthcare Provider Details

I. General information

NPI: 1073573010
Provider Name (Legal Business Name): NULTON DIAGNOSTIC & TREATMENT CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 COLLEGE PARK PLZ
JOHNSTOWN PA
15904-2833
US

IV. Provider business mailing address

214 COLLEGE PARK PLZ
JOHNSTOWN PA
15904-2833
US

V. Phone/Fax

Practice location:
  • Phone: 814-262-0025
  • Fax: 814-266-8745
Mailing address:
  • Phone: 814-262-0025
  • Fax: 814-266-8745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number314080
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number117055
License Number StatePA

VIII. Authorized Official

Name: LARRY J NULTON
Title or Position: OWNER
Credential:
Phone: 814-262-0025