Provider Demographics
NPI:1700086188
Name:POEPPERLING, JAMES OLIVER (LAC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:OLIVER
Last Name:POEPPERLING
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 RUSHBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:73 MONTAGE MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1850
Practice Address - Country:US
Practice Address - Phone:570-703-0755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019002225100000X
PAAK000628171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1700086188OtherGHP
PA25-1645055OtherHUMANA/CHOICE CARE
PA3054587OtherUHC
PA7613896OtherAETNA-PPO
PA8332033OtherAETNA-HMO
PA822682OtherFPH
PA002009303OtherBLUE SHIELD
PA338882J67Medicare PIN