MEDICARE: TYLER JACK LOOKABAUGH PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1043823693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER JACK LOOKABAUGH PT

Provider Business Mailing Address
First Line	:	546 STATE ROUTE 380
Second Line	:
City	:	MURRYSVILLE
State	:	PA
Zip	:	15668-2200
Country	:	US
Telephone Number	:	724-681-1239
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 WALNUT BOTTOM RD STE 306
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-3615
Country	:	US
Telephone Number	:	717-241-2211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	09/29/2020

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