=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467445858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH ANDOVER PHYSICL THERAPY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2005
-----------------------------------------------------
Last Update Date | 09/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 TURNPIKE ST
-----------------------------------------------------
City | NORTH ANDOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01845-5924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-686-9688
-----------------------------------------------------
Fax | 978-688-2163
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4716 OLD GETTYSBURG RD LEGAL DEPARTMENT
-----------------------------------------------------
City | MECHANICSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17055-4325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-975-4503
-----------------------------------------------------
Fax | 717-975-9981
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. MICHAEL E. TARVIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-975-4503
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------