Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | RT000203A | PA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT003023L | PA |
NPI | 1386683654 |
---|---|
Provider Name | Mr. Timothy Drevna |
First Address | Lancaster, PA 17601-4134 |
Second Address | Lancaster, PA 17601-4134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 04/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
413663 U5U | (02) | PA |
415471 | HEALTHAMERICA/ASSURANCE (01) | PA |
50057091 | BLUE CROSS AND KEYSTONE (01) | PA |
9415781 | PHCS (01) | PA |