Provider Demographics
NPI:1215323845
Name:CINICOLA, LARRY JOSEPH IV (DPT)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JOSEPH
Last Name:CINICOLA
Suffix:IV
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:119 PROFESSIONAL BUILDING
Mailing Address - Street 2:1265 WAYNE AVENUE, SUITE 308
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3501
Mailing Address - Country:US
Mailing Address - Phone:724-801-8095
Mailing Address - Fax:724-801-8147
Practice Address - Street 1:3215 N 5TH STREET HWY
Practice Address - Street 2:UNIT #4
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-2450
Practice Address - Country:US
Practice Address - Phone:484-509-4235
Practice Address - Fax:484-709-2754
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADAPT003925225100000X
PAPT024196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3931225000OtherIBC
PA50132432OtherCAPITAL BC
PA3160699OtherHIGHMARK
PA103008201Medicaid
PA103008201Medicaid
PA411859YENFMedicare PIN