Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 251C00000X | Day Training, Developmentally Disabled Services | | | | No |
| 2 | 225100000X | Physical Therapist | | | PENNSYLVANIA | No |
| 3 | 225800000X | Recreation Therapist | | | PENNSYLVANIA | No |
| 4 | 225A00000X | Music Therapist | | | PENNSYLVANIA | No |
| 5 | 225X00000X | Occupational Therapist | | | PENNSYLVANIA | No |
| 6 | 235Z00000X | Speech-Language Pathologist | | | PENNSYLVANIA | No |
| 7 | 251E00000X | Home Health | | | PENNSYLVANIA | No |
| 8 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | PENNSYLVANIA | No |
| 9 | 385HR2060X | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities | | PENNSYLVANIA | No |
| 10 | 315P00000X | Intermediate Care Facility, Intellectual Disabilities | | | PENNSYLVANIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1000013880049 | MEDICAID | PENNSYLVANIA | |
| 2 | 1000013880061 | MEDICAID | PENNSYLVANIA | |
| 3 | 1000013880040 | MEDICAID | PENNSYLVANIA | |
| 4 | 1000013880046 | MEDICAID | PENNSYLVANIA | |
| 5 | 1000013880047 | MEDICAID | PENNSYLVANIA | |
| 6 | 1000013880048 | MEDICAID | PENNSYLVANIA | |
| 7 | 1576770ST | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
| 8 | 1000013880063 | MEDICAID | PENNSYLVANIA | |
| 9 | 396772 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | THERAPY CLINIC |
| 10 | 1000013880050 | MEDICAID | PENNSYLVANIA | |
| 11 | 1000013880056 | MEDICAID | PENNSYLVANIA | |
| 12 | 1000013880058 | MEDICAID | PENNSYLVANIA | |
| 13 | 1000013880054 | MEDICAID | PENNSYLVANIA | |
| 14 | 1576764PT | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
| 15 | 1000013880055 | MEDICAID | PENNSYLVANIA | |
| 16 | 1000013880059 | MEDICAID | PENNSYLVANIA | |
| 17 | 1000013880031 | MEDICAID | PENNSYLVANIA | |
| 18 | 1000013880057 | MEDICAID | PENNSYLVANIA | |
| 19 | 1000013880034 | MEDICAID | PENNSYLVANIA | |
| 20 | 1000013880038 | MEDICAID | PENNSYLVANIA | |
| 21 | 1000013880001 | MEDICAID | PENNSYLVANIA | |
