Provider Demographics
NPI:1023017126
Name:CARRANZA, MARIO ALBERTO (PT)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ALBERTO
Last Name:CARRANZA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7307
Mailing Address - Country:US
Mailing Address - Phone:610-861-8080
Mailing Address - Fax:610-807-0366
Practice Address - Street 1:2775 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7307
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-807-0366
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008017L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P1643780OtherOXFORD HEALTH PLANS
PA748181OtherHIGHMARK BLUE SHIELD
0690022000OtherAMERIHEALTH
328979OtherHEALTHAMERICA/HEALTHASSUR
02093301OtherKEYSTONE HEALTH CENTRAL
4854485OtherCIGNA HEALTHCARE
02093301OtherCAPITAL BLUE CROSS
0467891OtherAETNA PPO
0690022000OtherINDEPENDENCE BLUE CROSS
821764OtherFIRST PRIORITY HEALTH
1398661OtherUNITED HEALTHCARE
2170551OtherMAMSI
0690022000OtherKEYSTONE HEALTH EAST
PA748181OtherHIGHMARK BLUE SHIELD
328979OtherHEALTHAMERICA/HEALTHASSUR