Provider Demographics
NPI:1265105712
Name:SLATER, JOHN ANDREW (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:SLATER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 N DEAN ST
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:IL
Mailing Address - Zip Code:61422-1231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-9702
Practice Address - Country:US
Practice Address - Phone:570-265-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-30924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist