Basic Information
Provider Information | |||||||||
NPI: | 1881940575 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HARTRANFT | ||||||||
FirstName: | REBECCA | ||||||||
MiddleName: | LEE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPT, CERT. MDT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GOULDTHREAD | ||||||||
OtherFirstName: | REBECCA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 7 DOCK HILL RD | ||||||||
Address2: |   | ||||||||
City: | MIDDLEBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 178428910 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5708372123 | ||||||||
FaxNumber: | 5708372185 | ||||||||
Practice Location | |||||||||
Address1: | 270 SUSQUEHANNA VALLEY MALL DR STE 400 | ||||||||
Address2: |   | ||||||||
City: | SELINSGROVE | ||||||||
State: | PA | ||||||||
PostalCode: | 178709115 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7176924708 | ||||||||
FaxNumber: | 7176925464 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/31/2012 | ||||||||
LastUpdateDate: | 07/08/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/08/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | DAPT003005 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 225100000X | PT022170 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 769548 | 01 | PA | MEDICARE | OTHER | 1027516450034 | 05 | PA |   | MEDICAID |