=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780873679
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TR ENTERPISE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2007
-----------------------------------------------------
Last Update Date | 10/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 N 16TH ST
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17837-1228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-524-6060
-----------------------------------------------------
Fax | 570-524-6061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 N 16TH ST
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17837-1228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-524-6060
-----------------------------------------------------
Fax | 570-524-6061
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/ CEO
-----------------------------------------------------
Name | MRS. CHRISTA EILEEN BROPHY
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 570-524-6060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------