Healthcare Provider Details

I. General information

NPI: 1396702981
Provider Name (Legal Business Name): SHANE J BRONSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2836 EARLYSTOWN RD SUITE 1
CENTRE HALL PA
16828-9162
US

IV. Provider business mailing address

4750 LINDLE ROAD SUITE 100
HARRISBURG PA
17111-2428
US

V. Phone/Fax

Practice location:
  • Phone: 814-974-2934
  • Fax: 814-414-4056
Mailing address:
  • Phone: 717-803-3342
  • Fax: 717-974-8743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016294
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: