MEDICARE: IXL REHAB & FITNESS CENTER 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	332B00000X	Durable Medical Equipment & Medical Supplies	4000007220	PA
2	332BC3200X	Customized Equipment (DME)	4000007220	PA
3	225100000X	Physical Therapist	PT005706-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669472999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IXL REHAB & FITNESS CENTER LLC

Provider Business Mailing Address
First Line	:	139 NORTH ERIE STREET
Second Line	:
City	:	MERCER
State	:	PA
Zip	:	16137-1204
Country	:	US
Telephone Number	:	724-662-1776
Fax Number	:	724-662-1858

Provider Business Practice Location Address
First Line	:	139 NORTH ERIE STREET
Second Line	:
City	:	MERCER
State	:	PA
Zip	:	16137-1204
Country	:	US
Telephone Number	:	724-662-1776
Fax Number	:	724-662-1858

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL J SHARR
Credential	:	PT, DPT, CLT-LANA
Telephone Number	:	724-662-1776

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	08/03/2016

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Directions to “IXL REHAB & FITNESS CENTER LLC ” Practice Location

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