Healthcare Provider Details

I. General information

NPI: 1649294844
Provider Name (Legal Business Name): TINA GIANNETTA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 PENN AVE MACKAREY & MACKAREY PHYSCIAL THERAPY CONSULTANTS, LLC
SCRANTON PA
18503-1932
US

IV. Provider business mailing address

240 PENN AVE MACKAREY & MACKAREY PHYSCIAL THERAPY CONSULTANTS, LLC
SCRANTON PA
18503-1932
US

V. Phone/Fax

Practice location:
  • Phone: 570-558-0290
  • Fax: 570-558-0291
Mailing address:
  • Phone: 570-558-0290
  • Fax: 570-558-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-018183
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018183
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier001877184
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE SHIELD
# 2
Identifier2770965000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerINDEPENDENCE BLUE SHIELD
# 3
Identifier1877184
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE SHIELD
# 4
Identifier50063358
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS
# 5
Identifier823040
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: