Healthcare Provider Details

I. General information

NPI: 1992188049
Provider Name (Legal Business Name): MARIA B CABA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BERK RD
LEESPORT PA
19533-8705
US

IV. Provider business mailing address

1043 CHRISTINA DR
LEESPORT PA
19533-8800
US

V. Phone/Fax

Practice location:
  • Phone: 610-376-4841
  • Fax:
Mailing address:
  • Phone: 484-721-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI004377
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: