Provider Demographics
NPI:1043204977
Name:MACKAREY, PAUL JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOSEPH
Last Name:MACKAREY
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 1:240 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1920
Mailing Address - Country:US
Mailing Address - Phone:570-558-0290
Mailing Address - Fax:570-558-0291
Practice Address - Street 1:240 PENN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1920
Practice Address - Country:US
Practice Address - Phone:570-558-0290
Practice Address - Fax:570-558-0291
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000917E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072445OtherFIRST PRIORITY HEALTH
PA650019415OtherRAILROAD MEDICARE
PAMA101885OtherPA BLUE SHIELD
PA66866159BOtherGEISINGER HEALTH PLAN
PA001815146Medicaid
PA2373037OtherUS/HEALTHCARE
PA7671144OtherAETNA
PA650019415OtherRAILROAD MEDICARE
PA041458PFFMedicare ID - Type Unspecified