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General NPI Number Information
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NPI Number | 1679841415
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Entity Type | Organization
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Legal Business Name | WILLIAMSPORT PHYSICAL MEDICINE, INC.
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 1101 E 3RD ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-5411
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Country | US
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Telephone | 570-322-5500
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Fax | 570-322-8100
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Provider Business Mailing Address
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Address Line | 1101 E 3RD ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-5411
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Country | US
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Telephone | 570-322-5500
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Fax | 570-322-8100
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Authorized Official
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Title or Position | PRESIDENT
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Name | FRANK J FORTE
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Credential | D.C.
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Telephone | 570-287-5560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN523038L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA052411
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD433098
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License Number State | PA
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