Healthcare Provider Details

I. General information

NPI: 1700810835
Provider Name (Legal Business Name): WILLIAM ALLEN STANG JR. A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SOUTH MAIN ST PHYSICAL THERAPY ASSOCIATES NEPA
OLD FORGE PA
18518
US

IV. Provider business mailing address

207 LILLIBRIDGE ST
PECKVILLE PA
18452
US

V. Phone/Fax

Practice location:
  • Phone: 570-457-4099
  • Fax: 570-457-7205
Mailing address:
  • Phone: 570-430-9389
  • Fax: 570-457-7205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier07970269
Identifier TypeOTHER
Identifier State
Identifier IssuerCERTIFICATION

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: