Provider Demographics
NPI:1063638062
Name:PHYSICAL THERAPY SERVICES OF HOMETOWN, INC.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF HOMETOWN, INC.
Other - Org Name:PHYSICAL THERAPY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KLEPCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-668-1889
Mailing Address - Street 1:219 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-4431
Mailing Address - Country:US
Mailing Address - Phone:570-668-1889
Mailing Address - Fax:570-668-6115
Practice Address - Street 1:219 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-4431
Practice Address - Country:US
Practice Address - Phone:570-668-1889
Practice Address - Fax:570-668-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008621225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GROUP # 800195OtherFIRST PRIORITY HEALTH
GROUP #0117094000OtherINDEPENDENCE BLUE CROSS
PA001894810 0005Medicaid
49550OtherHEALTH ASSURANCE
GROUP # E44038OtherAMERIHEALTH
02424300OtherCAPITAL BLUE CROSS
544038OtherHIGHMARK BLUE SHIELD
PA001894810 0005Medicaid
PA001894810 0005Medicaid
49550OtherHEALTH ASSURANCE