Provider Demographics
NPI:1649294844
Name:GIANNETTA, TINA (PT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:GIANNETTA
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:240 PENN AVE
Mailing Address - Street 2:MACKAREY & MACKAREY PHYSCIAL THERAPY CONSULTANTS, LLC
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1932
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:MACKAREY & MACKAREY PHYSCIAL THERAPY CONSULTANTS, LLC
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1932
Practice Address - Country:US
Practice Address - Phone:570-558-0290
Practice Address - Fax:570-558-0291
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAPT-018183225100000X
PAPT018183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
001877184OtherBLUE SHIELD
PA2770965000OtherINDEPENDENCE BLUE SHIELD
PA1877184OtherBLUE SHIELD
PA50063358OtherCAPITAL BLUE CROSS
PA823040OtherFIRST PRIORITY HEALTH