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General NPI Number Information
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NPI Number | 1932194271
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Entity Type | Organization
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Legal Business Name | SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS INC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 3120 N OLD TRAIL
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City | SHAMOKIN DAM
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State | PA
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Zip | 17876
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Country | US
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Telephone | 570-743-1414
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Fax | 570-743-5215
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Provider Business Mailing Address
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Address Line | PO BOX 243
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City | SHAMOKIN DAM
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State | PA
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Zip | 17876
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Country | US
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Telephone | 570-743-1414
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Fax | 570-743-5215
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Authorized Official
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Title or Position | OWNER CERTIFIED PROSTHETIST
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Name | MR. FRANK THOMAS DOMINICK III
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Credential | CP
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Telephone | 570-743-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | PA
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