Healthcare Provider Details

I. General information

NPI: 1013138890
Provider Name (Legal Business Name): HARRY LEE KERSTETTER JR. PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BERWICK RD
ORANGEVILLE PA
17859-9064
US

IV. Provider business mailing address

115 TOWER RD
SUNBURY PA
17801-6209
US

V. Phone/Fax

Practice location:
  • Phone: 570-683-8511
  • Fax:
Mailing address:
  • Phone: 570-274-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE001660L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI000571
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: