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Organization
SOSAR PHYSICAL THERAPY, LLC
Active
Organization
SOSAR PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA A. CONSTANTINE (BUSINESS MANAGER)
(570) 874-2125
Entity
Organization
Contact information
Practice address
649 S GARFIELD AVE, FRACKVILLE, PA 17931-2427
(570) 874-2125
(570) 874-4019
Mailing address
649 S GARFIELD AVE, FRACKVILLE, PA 17931-2427
(570) 874-2125
(570) 874-4019
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02642000
CAPITAL BLUE CROSS GROUP
PA
01
—
DA2003
RAILROAD MEDICARE GROUP #
PA
01
—
SO1425969
BLUE SHIELD GROUP NUMBER
PA
Enumeration date
05/23/2005
Last updated
08/22/2020
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