=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699565242
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAM HEALTH AT WESLEY CHAPEL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2025
-----------------------------------------------------
Last Update Date | 05/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4570 BRUCE B DOWNS BLVD
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-731-9660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1828 GOOD HOPE RD
-----------------------------------------------------
City | ENOLA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17025-1203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-731-9660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANTHONY MISITANO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-731-9660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------