Basic Information
| Provider Information | |||||||||
| NPI: | 1588639322 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANOSKY | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | RR 1 BOX 140C | ||||||||
| Address2: | |||||||||
| City: | TOWANDA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188489787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702657688 | ||||||||
| FaxNumber: | 5702657134 | ||||||||
| Practice Location | |||||||||
| Address1: | 542 BOULEVARD AVE | ||||||||
| Address2: | |||||||||
| City: | DICKSON CITY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185191750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704895010 | ||||||||
| FaxNumber: | 5704895060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 05/11/2009 | ||||||||
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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 | PT008081L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 071564PV9 | 01 | PA | MEDICARE PTAN | OTHER |