Healthcare Provider Details

I. General information

NPI: 1154376937
Provider Name (Legal Business Name): FAMILY PRACTICE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DOCK HILL RD
MIDDLEBURG PA
17842-8910
US

IV. Provider business mailing address

7 DOCK HILL RD
MIDDLEBURG PA
17842-8910
US

V. Phone/Fax

Practice location:
  • Phone: 570-837-2123
  • Fax: 570-837-2185
Mailing address:
  • Phone: 570-837-2123
  • Fax: 570-837-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BENJAMIN RYAN WILLIARD
Title or Position: CEO
Credential:
Phone: 570-743-1703