MEDICARE: REHABCLINICS SPT, 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	261QP2000X	Physical Therapy Clinic/Center		NJ

General Provider Information

NPI Number	:	1699771170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHABCLINICS SPT, INC.

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:	LEGAL DEPARTMENT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	6307 VENTNOR AVE
Second Line	:
City	:	VENTNOR
State	:	NJ
Zip	:	08406
Country	:	US
Telephone Number	:	609-822-2628
Fax Number	:	609-822-5173

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MICHAEL E. TARIVN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/31/2018

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