Healthcare Provider Details

I. General information

NPI: 1942906052
Provider Name (Legal Business Name): GLORIA EYNON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S MAIN AVE
SCRANTON PA
18504-2956
US

IV. Provider business mailing address

33 N MAIN ST STE 100
PITTSTON PA
18640-1949
US

V. Phone/Fax

Practice location:
  • Phone: 570-207-2787
  • Fax: 570-207-2788
Mailing address:
  • Phone: 570-208-2787
  • Fax: 570-208-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI001219
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: