Provider Demographics
NPI:1043306087
Name:KRAVETZ, JOHN III (MPT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:KRAVETZ
Suffix:III
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 REGENT CT
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7965
Mailing Address - Country:US
Mailing Address - Phone:814-231-2101
Mailing Address - Fax:814-231-8569
Practice Address - Street 1:1505 9TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2416
Practice Address - Country:US
Practice Address - Phone:814-949-4050
Practice Address - Fax:814-940-2026
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013444L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA206217OtherHEALTH AMER/HEALTH ASSUR.
PAKR1407249OtherHIGHMARK BLUE SHIELD
PA206217OtherHEALTH AMER/HEALTH ASSUR.