Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT011733L | PA |
N | 2251S0007X | Physical Therapist - Sports | PT011733L | PA |
N | 2251X0800X | Physical Therapist - Orthopedic | MD011733L | PA |
NPI | 1053412866 |
---|---|
Provider Name | Diane M Rakos |
First Address | Boston, MA 02284-8269 |
Second Address | Allentown, PA 18104-9168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 31/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0052130 | ORTHONET (01) | PA |
1896402 | BLUE SHIELD (01) | PA |
1896402 | FIRST PRIORITY LIFE (01) | |
50052969 | CAPITAL BLUE CROSS (01) | PA |
50052969 | KEYSTONE CENTRAL (01) | PA |
7926898 | AETNA (01) | PA |