Provider Demographics
NPI:1679953186
Name:MACKAREY, PAUL JOHN (PT DPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JOHN
Last Name:MACKAREY
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1932
Mailing Address - Country:US
Mailing Address - Phone:570-558-0290
Mailing Address - Fax:570-558-0291
Practice Address - Street 1:240 PENN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1932
Practice Address - Country:US
Practice Address - Phone:570-558-0290
Practice Address - Fax:570-558-0291
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATPT021635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist