Basic Information
Provider Information | |||||||||
NPI: | 1073828364 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RODIO | ||||||||
FirstName: | NICHOLAS | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 24569 ROUTE 6 | ||||||||
Address2: | SUITE C | ||||||||
City: | TOWANDA | ||||||||
State: | PA | ||||||||
PostalCode: | 188485254 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5702651111 | ||||||||
FaxNumber: | 5702657134 | ||||||||
Practice Location | |||||||||
Address1: | 7731 ROUTE 6 | ||||||||
Address2: |   | ||||||||
City: | TROY | ||||||||
State: | PA | ||||||||
PostalCode: | 169479253 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5702972774 | ||||||||
FaxNumber: | 5702973547 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/11/2010 | ||||||||
LastUpdateDate: | 11/18/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT020891 | PA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.