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General NPI Number Information
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NPI Number | 1164773768
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Entity Type | Individual
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Provider Name | ALAN GEORGE
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Gender | Male
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Dates
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Enumeration Date | 09/24/2012
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 525 GROFF AVE
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City | ELIZABETHTOWN
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State | PA
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Zip | 17022-2824
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Country | US
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Telephone | 717-201-2716
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Fax |
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Provider Business Mailing Address
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Address Line | 525 GROFF AVE
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City | ELIZABETHTOWN
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State | PA
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Zip | 17022-2824
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | PT26976
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | PT020051
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | 070.019226
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License Number State | IL
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