Healthcare Provider Details

I. General information

NPI: 1609917822
Provider Name (Legal Business Name): MR. MICHAEL MESZAROS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
TOWANDA PA
18848-9710
US

IV. Provider business mailing address

1 HOSPITAL DR
TOWANDA PA
18848-9710
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-2191
  • Fax: 570-268-2379
Mailing address:
  • Phone: 570-265-2191
  • Fax: 570-268-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007938L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPT007938L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerTHERAPY LICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: