Healthcare Provider Details

I. General information

NPI: 1003199084
Provider Name (Legal Business Name): EASTER SEALS CENTRAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 ROLLING RIDGE DR
STATE COLLEGE PA
16801-7679
US

IV. Provider business mailing address

383 ROLLING RIDGE DR
STATE COLLEGE PA
16801-7679
US

V. Phone/Fax

Practice location:
  • Phone: 814-689-1911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019699
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPT019699
License Number StatePA

VIII. Authorized Official

Name: CARRIE RYAN
Title or Position: EXECUTIVE VP/CFO
Credential:
Phone: 814-689-1911