Healthcare Provider Details

I. General information

NPI: 1245718774
Provider Name (Legal Business Name): ANGELA JANE PARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PENN AVE
SCRANTON PA
18503-1213
US

IV. Provider business mailing address

427 GROVE ST
PECKVILLE PA
18452-1807
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-4360
  • Fax:
Mailing address:
  • Phone: 570-591-0209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT027165
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: