Healthcare Provider Details

I. General information

NPI: 1528206620
Provider Name (Legal Business Name): MCCUEN & ASSOCIATES PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 LINGLESTOWN ROAD SUITE 2
HARRISBURG PA
17112-1153
US

IV. Provider business mailing address

4033 LINGLESTOWN ROAD SUITE 2
HARRISBURG PA
17112-1153
US

V. Phone/Fax

Practice location:
  • Phone: 717-920-5002
  • Fax: 707-920-5224
Mailing address:
  • Phone: 717-920-5002
  • Fax: 707-920-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. STUART S BASOM
Title or Position: OWNER
Credential: P.T.
Phone: 717-737-9818