Basic Information
| Provider Information | |||||||||
| NPI: | 1396702981 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRONSON | ||||||||
| FirstName: | SHANE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 DERRY ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171113576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178392110 | ||||||||
| FaxNumber: | 7175651934 | ||||||||
| Practice Location | |||||||||
| Address1: | 5275 E TRINDLE RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170503502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177909920 | ||||||||
| FaxNumber: | 7177909923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 01/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT016294 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.