Basic Information
| Provider Information | |||||||||
| NPI: | 1093739559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POVANDA | ||||||||
| FirstName: | BERNARD | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 KIPLING DR | ||||||||
| Address2: | |||||||||
| City: | MOOSIC | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185071933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703449585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OLD FORGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185181541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704574099 | ||||||||
| FaxNumber: | 5704577225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT005968L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 650012236 | 01 | RAILROAD MEDICARE | OTHER | 072427 | 01 | FIRST PRIORITY HEALTH | OTHER | 472307 | 01 | AMERI HEALTH | OTHER | 235569 | 01 | HEALTH AMERICA | OTHER | 472307Q69 | 01 | STERLING OPTIONS I | OTHER | 472307 | 01 | HIGHMARK BLUE SHIELD | OTHER | 9357839 | 01 | CIGNA | OTHER |