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Individual

EDWARD C DESMET JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSPT

Contact information

Practice address
1564 ROUTE 507, SUITE C, GREENTOWN, PA 18426-4502
(570) 676-0700
(570) 676-0766
Mailing address
RR 1 BOX 140C, TOWANDA, PA 18848-9787
(570) 265-1111
(570) 265-7134

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-011714L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0066515000
INDEPENDENCE BLUE SHIELD
PA
01
171758
BLUE SHIELD
PA
01
2495044
AETNA
PA
01
50017318
CAPITAL BLUE CROSS
PA
01
812635
FIRST PRIORITY
PA
Enumeration date
11/17/2005
Last updated
03/11/2010
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