MEDICARE: NORTH PENN THERAPEUTICS AND PHYSICAL THERAPY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PT009652L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	457211	OTHER	PA	BLUE SHIELD PROVIDER NUMB

General Provider Information

NPI Number	:	1083612048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH PENN THERAPEUTICS AND PHYSICAL THERAPY, INC

Provider Business Mailing Address
First Line	:	512 E COLUMBUS AVE
Second Line	:
City	:	CORRY
State	:	PA
Zip	:	16407-9014
Country	:	US
Telephone Number	:	814-664-9346
Fax Number	:	814-663-0169

Provider Business Practice Location Address
First Line	:	512 E COLUMBUS AVE
Second Line	:
City	:	CORRY
State	:	PA
Zip	:	16407-9014
Country	:	US
Telephone Number	:	814-664-9346
Fax Number	:	814-663-0169

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MR. GORDON R BAILEY
Credential	:	MPT
Telephone Number	:	814-664-9346

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	01/27/2010

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