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General NPI Number Information
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NPI Number | 1003487133
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Entity Type | Individual
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Provider Name | JOHN KLINE PTA
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Gender | Male
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 401 BROAD ST
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City | JOHNSTOWN
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State | PA
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Zip | 15906-2745
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Country | US
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Telephone | 814-535-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 401 BROAD ST
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City | JOHNSTOWN
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State | PA
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Zip | 15906-2745
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Country | US
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Telephone | 814-535-6000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | TEI002759
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TEI002759
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License Number State | PA
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