Provider Demographics
NPI:1588646178
Name:PANTINOPLE, HERNANI (PT)
Entity Type:Individual
Prefix:
First Name:HERNANI
Middle Name:
Last Name:PANTINOPLE
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 1:223 BLUE MOUNTAIN LK
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8691
Mailing Address - Country:US
Mailing Address - Phone:201-281-3619
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 110
Practice Address - Street 2:ROUTE209
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-9532
Practice Address - Country:US
Practice Address - Phone:570-992-4400
Practice Address - Fax:570-992-5262
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011887L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1544361OtherBLUE SHIELD
PA3344354OtherAETNA
PA817259OtherFIRST PRIORITY
PA50031258OtherCAPITAL BLUE CROSS