Healthcare Provider Details

I. General information

NPI: 1578557401
Provider Name (Legal Business Name): MATTHEW T SCALESE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MORGAN HWY SUITE 4
SCRANTON PA
18508-2641
US

IV. Provider business mailing address

5 MORGAN HWY SUITE 4
SCRANTON PA
18508-2641
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-3788
  • Fax: 570-969-9280
Mailing address:
  • Phone: 570-344-3788
  • Fax: 570-969-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT011807L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier001702320
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1578557401
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUHC COMMERCIAL
# 3
IdentifierP00016183
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRAILROAD MEDICARE
# 4
Identifier66866-159B
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER HEALTH PLAN
# 5
IdentifierSC974488
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA BLUE SHIELD
# 6
Identifier1578557401
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCOVENTRY-HEALTH AMERICA-HEALTH ASSURANCE
# 7
Identifier5414658
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 8
Identifier816686
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY HEALTH
# 9
Identifier1578557401
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHUMANA/CHOICE CARE
# 10
Identifier3263156
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUS HEALTHCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: