Healthcare Provider Details

I. General information

NPI: 1336539808
Provider Name (Legal Business Name): TOTAL ACCESSIBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 COAL ST
PORT CARBON PA
17965-1834
US

IV. Provider business mailing address

108 COAL ST
PORT CARBON PA
17965-1834
US

V. Phone/Fax

Practice location:
  • Phone: 570-622-7785
  • Fax:
Mailing address:
  • Phone: 570-622-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN PONTICIAN
Title or Position: PARTNER
Credential:
Phone: 570-622-7785