Provider Demographics
NPI:1013902360
Name:MACKAREY, ESTHER G (PT)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:G
Last Name:MACKAREY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:
Other - Last Name:GUNDRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:240 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1920
Mailing Address - Country:US
Mailing Address - Phone:570-558-0290
Mailing Address - Fax:570-558-0291
Practice Address - Street 1:240 PENN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1920
Practice Address - Country:US
Practice Address - Phone:570-558-0290
Practice Address - Fax:570-558-0291
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000928E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA66866159BOtherGEISINGER HEALTH PLAN
PA7100139OtherAETNA
PAMA881376OtherBLUE SHIELD
812014OtherFIRST PRIORITY HEALTH
PA2373020OtherUS HEALTHCARE
PA001815137Medicaid
P12546Medicare UPIN
812014OtherFIRST PRIORITY HEALTH
PA001815137Medicaid