Provider Demographics
NPI:1093739559
Name:POVANDA, BERNARD JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:JOSEPH
Last Name:POVANDA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21 KIPLING DR
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1933
Mailing Address - Country:US
Mailing Address - Phone:570-344-9585
Mailing Address - Fax:
Practice Address - Street 1:501 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1541
Practice Address - Country:US
Practice Address - Phone:570-457-4099
Practice Address - Fax:570-457-7225
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005968L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
650012236OtherRAILROAD MEDICARE
072427OtherFIRST PRIORITY HEALTH
472307OtherAMERI HEALTH
235569OtherHEALTH AMERICA
472307Q69OtherSTERLING OPTIONS I
472307OtherHIGHMARK BLUE SHIELD
9357839OtherCIGNA
472307OtherAMERI HEALTH
472307Q69OtherSTERLING OPTIONS I