Healthcare Provider Details

I. General information

NPI: 1588638803
Provider Name (Legal Business Name): WYOMING VALLEY PROSTHETICS AND ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AVENUE A
SWOYERSVILLE PA
18704
US

IV. Provider business mailing address

300 AVENUE A
SWOYERSVILLE PA
18704
US

V. Phone/Fax

Practice location:
  • Phone: 570-283-3835
  • Fax: 570-283-3805
Mailing address:
  • Phone: 570-283-3835
  • Fax: 570-283-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. DANTE C MOLINO
Title or Position: OWNER
Credential: CPO
Phone: 570-283-3835