Basic Information
| Provider Information | |||||||||
| NPI: | 1972744753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIGIAMBATTISTA | ||||||||
| FirstName: | STEPHEN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24569 ROUTE 6 | ||||||||
| Address2: | SUITE C | ||||||||
| City: | TOWANDA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188488254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702651111 | ||||||||
| FaxNumber: | 5702657134 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOSCOW | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184449003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708428191 | ||||||||
| FaxNumber: | 5708428192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2009 | ||||||||
| LastUpdateDate: | 03/15/2011 | ||||||||
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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 | PT019831 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2101264 | 01 | PA | FIRST PRIORITY LIFE INSURANCE | OTHER | 824262 | 01 | PA | FIRST PRIORITY HEALTH | OTHER | 2101264 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |