MEDICARE: MS. MARILYN A. MIELE RPT

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	225100000X	Physical Therapist	PT1462E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201031331	OTHER	PA	TAX ID

General Provider Information

NPI Number	:	1770516866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARILYN A. MIELE RPT

Provider Business Mailing Address
First Line	:	5300 DERRY ST 2ND
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17111-3576
Country	:	US
Telephone Number	:	717-839-2110
Fax Number	:	717-565-1934

Provider Business Practice Location Address
First Line	:	781 FAR HILLS DR
Second Line	:	SUITE 400
City	:	NEW FREEDOM
State	:	PA
Zip	:	17349-8447
Country	:	US
Telephone Number	:	717-235-9890
Fax Number	:	717-235-9894

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	11/17/2015

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