MEDICARE: MRS. TAMARA ELIZABETH DRAGON P.T.

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	13289	MA

General Provider Information

NPI Number	:	1841464898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA ELIZABETH DRAGON P.T.

Provider Business Mailing Address
First Line	:	200 N POINT CIR
Second Line	:
City	:	SEVEN FIELDS
State	:	PA
Zip	:	16046-7861
Country	:	US
Telephone Number	:	570-226-3321
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 N POINT CIR
Second Line	:
City	:	SEVEN FIELDS
State	:	PA
Zip	:	16046-7861
Country	:	US
Telephone Number	:	570-226-3321
Fax Number	:

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

Provider Enumeration Date	:	04/19/2008
Last Update Date	:	04/19/2008

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