Healthcare Provider Details

I. General information

NPI: 1538351945
Provider Name (Legal Business Name): NOVACARE OUTPATIENT REHABILITATION EAST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 TRANSFER RD SUITE 16
SAINT PAUL MN
55114-1427
US

IV. Provider business mailing address

4716 OLD GETTYSBURG RD LEGAL DEPARTMENT
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 651-646-1625
  • Fax: 651-656-3256
Mailing address:
  • Phone: 717-975-4503
  • Fax: 717-975-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TARVIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-975-4503