Provider Demographics
NPI:1497742845
Name:KOKINDA, RICHARD BRYANT (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRYANT
Last Name:KOKINDA
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 1:219 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
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005940L225100000X
2251G0304X, 2251X0800X, 2251S0007X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
225864OtherHEALTH ASSURANCE
989050OtherKEYSTONE
27991000OtherINDEPENDENCE BLUE CROSS
814769OtherFIRST PRIORITY HEALTH
01863702OtherCAPITAL BLUE CROSS
65002322OtherRAILROAD MEDICARE
11228153OtherCAQH
2841916OtherAETNA HMO
481407OtherHIGHMARK BLUE SHIELD
7945348OtherAETNA PPO
7945348OtherAETNA PPO
57935M1LMedicare ID - Type Unspecified