MEDICARE: CLNICAL NEURODIAGNOSTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251E1300X	Clinical Electrophysiology Physical Therapist

General Provider Information

NPI Number	:	1437201506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLNICAL NEURODIAGNOSTICS

Provider Business Mailing Address
First Line	:	480 PIERCE ST STE 215
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-5512
Country	:	US
Telephone Number	:	570-288-7181
Fax Number	:	570-288-7633

Provider Business Practice Location Address
First Line	:	480 PIERCE ST STE 215
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-5512
Country	:	US
Telephone Number	:	570-288-7181
Fax Number	:	570-288-7633

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD L READ
Credential	:	PT
Telephone Number	:	570-288-7181

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/09/2008

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Directions to “CLNICAL NEURODIAGNOSTICS ” Practice Location

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