Healthcare Provider Details

I. General information

NPI: 1912607748
Provider Name (Legal Business Name): NICHOLAS POPLARCHICK PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FLORIDA AVE
SCRANTON PA
18505-2827
US

IV. Provider business mailing address

118 BARBARA LN
TAYLOR PA
18517-9701
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-7381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI005895
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: