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General NPI Number Information
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NPI Number | 1104970227
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Entity Type | Organization
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Legal Business Name | LYCOMING COUNTY CRIPPLED CHILDREN'S
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 625 W EDWIN ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701
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Country | US
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Telephone | 570-326-0565
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Fax | 570-329-2522
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Provider Business Mailing Address
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Address Line | 625 W EDWIN ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701
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Country | US
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Telephone | 570-326-0565
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Fax | 570-329-2522
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ANTHONY P. PERROTTA
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Credential |
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Telephone | 570-326-0565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT000490E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT002737L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT016332L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OC006418L
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL002712L
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PS005489L
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License Number State | PA
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Taxonomy #7
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS005489L
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License Number State | PA
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Taxonomy #8
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS005489L
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License Number State | PA
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Taxonomy #9
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL000825L
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License Number State | PA
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