Provider Demographics
NPI:1881997005
Name:WILLIAMSPORT PHYSICAL MEDICINE, INC.
Entity type:Organization
Organization Name:WILLIAMSPORT PHYSICAL MEDICINE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:FORTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-322-5500
Mailing Address - Street 1:1101 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5411
Mailing Address - Country:US
Mailing Address - Phone:570-322-5500
Mailing Address - Fax:570-322-8100
Practice Address - Street 1:250 PIERCE ST
Practice Address - Street 2:SUITE 108
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5149
Practice Address - Country:US
Practice Address - Phone:570-287-5560
Practice Address - Fax:570-287-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies