=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750501292
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELO L GIUNTA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 N 2ND ST REAR
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17837-1564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-523-0822
-----------------------------------------------------
Fax | 570-523-0846
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 N 2ND ST REAR
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17837-1564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-523-0822
-----------------------------------------------------
Fax | 570-523-0846
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 222Z00000X
-----------------------------------------------------
Taxonomy Name | Orthotist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------