Provider Demographics
NPI:1679574859
Name:CENTRAL MOUNTAIN PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:CENTRAL MOUNTAIN PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:S
Authorized Official - Last Name:DINGES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:570-748-2678
Mailing Address - Street 1:685 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-8844
Mailing Address - Country:US
Mailing Address - Phone:570-748-2678
Mailing Address - Fax:570-748-4015
Practice Address - Street 1:685 ISLAND RD
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-8844
Practice Address - Country:US
Practice Address - Phone:570-748-2678
Practice Address - Fax:570-748-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007705L174400000X
PAPT007553L174400000X
PAPT009179L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001888394Medicaid
PA347875600OtherUS DEPT OF LABOR
PA928954OtherBC/BS-GROUP
PA63410 9969OtherGEISINGER-GROUP
PA140512OtherHEALTH AMERICA-GROUP