Provider Demographics
NPI:1972744753
Name:DIGIAMBATTISTA, STEPHEN (DPT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:DIGIAMBATTISTA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24569 ROUTE 6
Mailing Address - Street 2:SUITE C
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-8254
Mailing Address - Country:US
Mailing Address - Phone:570-265-1111
Mailing Address - Fax:570-265-7134
Practice Address - Street 1:330 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444-9003
Practice Address - Country:US
Practice Address - Phone:570-842-8191
Practice Address - Fax:570-842-8192
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2101264OtherFIRST PRIORITY LIFE INSURANCE
PA824262OtherFIRST PRIORITY HEALTH
PA2101264OtherHIGHMARK BLUE SHIELD
PA2101264OtherFIRST PRIORITY LIFE INSURANCE