Healthcare Provider Details

I. General information

NPI: 1306628904
Provider Name (Legal Business Name): DINA KILLIAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 SCRANTON CARBONDALE HWY
SCRANTON PA
18508-1115
US

IV. Provider business mailing address

423 SCRANTON CARBONDALE HWY
SCRANTON PA
18508-1115
US

V. Phone/Fax

Practice location:
  • Phone: 570-207-5502
  • Fax:
Mailing address:
  • Phone: 572-075-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE1000776
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: