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 | 225100000X | Physical Therapist | | PT016934 | PENNSYLVANIA | No |
| 2 | 2251X0800X | Physical Therapist | Orthopedic | 11677 | NORTH CAROLINA | 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 | 2170560 | OTHER | | MAMSI |
| 2 | 2353697000 | OTHER | | KEYSTONE HEALTH EAST |
| 3 | 2353697000 | OTHER | | AMERIHEALTH |
| 4 | 821692 | OTHER | | FIRST PRIORITY HEALTH |
| 5 | P00259443 | OTHER | | MEDICARE RAILROAD |
| 6 | 1679776 | OTHER | | HIGHMARK BLUE SHIELD |
| 7 | 2504284 | OTHER | NORTH CAROLINA | MEDICARE NUMBER |
| 8 | 7439972 | OTHER | | CIGNA HEALTHCARE |
| 9 | 088338 | MEDICARE PIN | PENNSYLVANIA | |
| 10 | 2068297 | OTHER | | UNITED HEALTHCARE |
| 11 | P3615017 | OTHER | | OXFORD HEALTH PLANS |
| 12 | 50045030 | OTHER | | KEYSTONE HEALTH CENTRAL |
| 13 | 47241 | OTHER | | GEISINGER HEALTH PLAN |
| 14 | 50045030 | OTHER | | CAPITAL BLUE CROSS |
| 15 | 2353697000 | OTHER | | INDEPENDENCE BLUE CROSS |
| 16 | 329154 | OTHER | | HEALTHAMERICA/HEALTHASSUR |
| 17 | 7038213 | OTHER | | AETNA PPO |
