Healthcare Provider Details

I. General information

NPI: 1881997005
Provider Name (Legal Business Name): WILLIAMSPORT PHYSICAL MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PIERCE ST SUITE 108
KINGSTON PA
18704-5149
US

IV. Provider business mailing address

1101 E 3RD ST
WILLIAMSPORT PA
17701-5411
US

V. Phone/Fax

Practice location:
  • Phone: 570-287-5560
  • Fax: 570-287-1107
Mailing address:
  • Phone: 570-322-5500
  • Fax: 570-322-8100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StatePA

VIII. Authorized Official

Name: FRANK J FORTE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 570-322-5500