MEDICARE: MR. SHAUN BRIAN TRUMBOWER PTA

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	225200000X	Physical Therapy Assistant	TE1000361	PA

General Provider Information

NPI Number	:	1508190513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAUN BRIAN TRUMBOWER PTA

Provider Business Mailing Address
First Line	:	128 BROADWAY RD
Second Line	:
City	:	SWEET VALLEY
State	:	PA
Zip	:	18656-2326
Country	:	US
Telephone Number	:	570-256-4487
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 BROADWAY RD
Second Line	:
City	:	SWEET VALLEY
State	:	PA
Zip	:	18656-2326
Country	:	US
Telephone Number	:	570-256-4487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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