Basic Information
Provider Information
NPI: 1144326372
EntityType: 2
ReplacementNPI:  
OrganizationName: PHYSIOTHERAPY ASSOCIATES INC
LastName:  
FirstName:  
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NameSuffix:  
Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 4714 GETTYSBURG RD
Address2: LEGAL DEPT
City: MECHANICSBURG
State: PA
PostalCode: 170554325
CountryCode: US
TelephoneNumber: 7179721100
FaxNumber:  
Practice Location
Address1: 3300 OLNEY SANDY SPRING RD
Address2: SUITE 300, THIRD FLOOR
City: OLNEY
State: MD
PostalCode: 208323302
CountryCode: US
TelephoneNumber: 3012608383
FaxNumber: 3012608894
Other Information
ProviderEnumerationDate: 09/15/2006
LastUpdateDate: 11/09/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: TARVIN
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName: E
AuthorizedOfficialTitleorPosition: VICE PRESIDENT & SECRETARY
AuthorizedOfficialTelephone: 7179721100
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR0400X  Y Ambulatory Health Care FacilitiesClinic/CenterRehabilitation

No ID Information.


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