MEDICARE: MRS. STEFANIE MAIRE LIEB DPT

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	PT019344	PA

General Provider Information

NPI Number	:	1891954814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEFANIE MAIRE LIEB DPT

Provider Business Mailing Address
First Line	:	310 PENN ST
Second Line	:	SUITE 103
City	:	HOLLIDAYSBURG
State	:	PA
Zip	:	16648-2044
Country	:	US
Telephone Number	:	814-695-2923
Fax Number	:	814-695-2924

Provider Business Practice Location Address
First Line	:	1 HOSPITAL DR
Second Line	:
City	:	TYRONE
State	:	PA
Zip	:	16686-1810
Country	:	US
Telephone Number	:	814-684-6309
Fax Number	:	814-684-6312

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

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/26/2008

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