MEDICARE: PRANA PHYSICAL THERAPY, LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1255585287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRANA PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	617A NORTH PRINCE STREET
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603
Country	:	US
Telephone Number	:	717-390-4822
Fax Number	:	717-390-4825

Provider Business Practice Location Address
First Line	:	617 N PRINCE ST # A
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-4769
Country	:	US
Telephone Number	:	717-390-4822
Fax Number	:	717-390-4825

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DAWN COX
Credential	:
Telephone Number	:	717-917-9136

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	05/12/2010

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