MEDICARE: LIFEBRIDGE SPORTS MEDICINE & REHABILITATION LLC

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	261QP2000X	Physical Therapy Clinic/Center
2	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1134291156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEBRIDGE SPORTS MEDICINE & REHABILITATION LLC

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:	LEGAL DEPT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1836 GREENE TREE RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21208-1301
Country	:	US
Telephone Number	:	410-486-9992
Fax Number	:	410-486-8680

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JOHN F DUGGAN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	10/20/2025

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