Provider Demographics
NPI:1023011186
Name:SOSAR PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:SOSAR PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONSTANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-874-2125
Mailing Address - Street 1:649 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:FRACKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17931-2427
Mailing Address - Country:US
Mailing Address - Phone:570-874-2125
Mailing Address - Fax:570-874-4019
Practice Address - Street 1:649 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2427
Practice Address - Country:US
Practice Address - Phone:570-874-2125
Practice Address - Fax:570-874-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADA2003OtherRAILROAD MEDICARE GROUP #
PASO1425969OtherBLUE SHIELD GROUP NUMBER
PA02642000OtherCAPITAL BLUE CROSS GROUP
PASO1425969OtherBLUE SHIELD GROUP NUMBER
PASO064949Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER