Provider Demographics
NPI:1164528899
Name:FOLEY, SEAN CEPHAS (MPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:CEPHAS
Last Name:FOLEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FIELDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1268
Mailing Address - Country:US
Mailing Address - Phone:570-574-6541
Mailing Address - Fax:
Practice Address - Street 1:401 COAL ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6626
Practice Address - Country:US
Practice Address - Phone:570-574-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009781225100000X
PADAPT000302225100000X
PAPT009781L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA819145OtherBCNE/FPH
PA50047625OtherCAPITAL/KHPC
PA5189656OtherAETNA - NON HMO
PA262304OtherHEALTH AMER/HEALTH ASSUR.
PA895215OtherHIGHMARK BLUE SHIELD
PA895215OtherHIGHMARK BLUE SHIELD