Provider Demographics
NPI:1023457058
Name:ADVANCED MEDICAL AND REHAB OF WILLIAMSPORT, P.C.
Entity type:Organization
Organization Name:ADVANCED MEDICAL AND REHAB OF WILLIAMSPORT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOKACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-322-1245
Mailing Address - Street 1:100 ECK CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3876
Mailing Address - Country:US
Mailing Address - Phone:570-322-1245
Mailing Address - Fax:
Practice Address - Street 1:100 ECK CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3876
Practice Address - Country:US
Practice Address - Phone:570-322-1245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111NS0005X, 225100000X, 207LP2900X
PAMD456537207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty