Individual
MR. DOUGLAS JOHN DENNISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
219 CLAREMONT AVE, TAMAQUA, PA 18252-4431
(570) 668-1889
(570) 668-6115
Mailing address
219 CLAREMONT AVE, TAMAQUA, PA 18252-4431
(570) 889-5568
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT017594
PA
2251G0304X
Geriatric Physical Therapist
—
—
2251P0200X
Pediatric Physical Therapist
—
—
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073637
AETNA HMO
—
01
—
11516549
CAQH
—
01
—
2002374
KEYSTONE
—
01
—
2451219000
INDEPENDENCE BLUE CROSS
—
01
—
268316
HEALTH ASSURANCE
—
01
—
50054393
CAPITAL BLUE CROSS
—
01
—
7146701
AETNA PPO
—
01
—
819644
FIRST PRIORITY HEALTH
—
01
—
DE1769215
HIGHMARK BLUE SHIELD
—
Enumeration date
09/29/2005
Last updated
04/08/2010
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