Active NPI
Gerald Dietrich
- Physical Therapist
- Portage, PA
National Provider Identifier
1003512401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT030043
- Practice address
- 4112 Springhill Rd
Portage, PA 15946-7402 - Phone
- (814) 506-8212
- Fax
- (814) 506-8213
- NPI assigned
- Feb 7, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT030043 | PA | Primary |
Addresses
Primary practice location
4112 Springhill Rd
Portage, PA 15946-7402
Mailing address
PO Box 870
Huntingdon, PA 16652-0870
Phone (814) 506-8212
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT030043 | PA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benchmark Therapy, Inc. | Past | Accepting new patients | |
| Benchmark Therapy, Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Philadelphia, PA
- NPI 1922553965
-
- Physical Therapy Clinic/Center
- Duncansville, PA
- NPI 1457365439
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675728000000",
"number": "1003512401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 870",
"city": "HUNTINGDON",
"state": "PA",
"postal_code": "166520870",
"telephone_number": "814-506-8212",
"fax_number": "814-506-8213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4112 SPRINGHILL RD",
"city": "PORTAGE",
"state": "PA",
"postal_code": "159467402",
"telephone_number": "814-506-8212",
"fax_number": "814-506-8213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETRICH",
"first_name": "GERALD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-02-07",
"last_updated": "2023-02-07",
"certification_date": "2023-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT030043",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.