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General NPI Number Information
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NPI Number | 1629476569
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Entity Type | Individual
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Provider Name | RHONDA GAIZICK PTA
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Gender | Female
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Dates
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Enumeration Date | 12/09/2014
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 500 FOWLER AVE SUITE 104
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City | BERWICK
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State | PA
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Zip | 18603-3326
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Country | US
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Telephone | 570-759-2000
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Fax | 570-585-1321
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Provider Business Mailing Address
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Address Line | 500 FOWLER AVE SUITE 104
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City | BERWICK
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State | PA
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Zip | 18603-3326
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Country | US
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Telephone | 570-759-2000
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Fax | 570-585-1321
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | TEI000559
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License Number State | PA
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