MEDICARE: HERNANI PANTINOPLE PT

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	225100000X	Physical Therapist	PT011887L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1544361	OTHER	PA	BLUE SHIELD
2	3344354	OTHER	PA	AETNA
3	817259	OTHER	PA	FIRST PRIORITY
4	50031258	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1588646178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERNANI PANTINOPLE PT

Provider Business Mailing Address
First Line	:	223 BLUE MOUNTAIN LK
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-8691
Country	:	US
Telephone Number	:	201-281-3619
Fax Number	:

Provider Business Practice Location Address
First Line	:	HC 1 BOX 110
Second Line	:	ROUTE209
City	:	BRODHEADSVILLE
State	:	PA
Zip	:	18322-9532
Country	:	US
Telephone Number	:	570-992-4400
Fax Number	:	570-992-5262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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Directions to “ HERNANI PANTINOPLE PT” Practice Location

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