Provider Demographics
NPI:1437611845
Name:ISGATE/KOTINSLY, CAROLINE
Entity Type:Individual
Prefix:PROF
First Name:CAROLINE
Middle Name:
Last Name:ISGATE/KOTINSLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:RINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17967-9598
Mailing Address - Country:US
Mailing Address - Phone:570-889-5926
Mailing Address - Fax:
Practice Address - Street 1:500 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2018
Practice Address - Country:US
Practice Address - Phone:570-874-0696
Practice Address - Fax:570-874-3749
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000239L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant