=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396759296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE REHABILITATION MEDICINE TEAM, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 09/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4518 UNION DEPOSIT RD
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17111-2921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-991-5030
-----------------------------------------------------
Fax | 717-540-0845
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 126638
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17112-6638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-991-5030
-----------------------------------------------------
Fax | 717-540-0845
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHRISTOPHER SCOTT CANNON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 717-991-5030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD044026E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------