Provider Demographics
NPI:1669102380
Name:PARADIS, CONCETTA
Entity type:Individual
Prefix:
First Name:CONCETTA
Middle Name:
Last Name:PARADIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:PA
Mailing Address - Zip Code:18641
Mailing Address - Country:US
Mailing Address - Phone:570-574-2368
Mailing Address - Fax:
Practice Address - Street 1:1000 EAST MOUNTAIN BOULEVARD
Practice Address - Street 2:PEARSALL HEART HOSPITAL 2ND FLOOR
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-808-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist