MEDICARE: AILEEN BERNAS MITROVIC 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	PT009143E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174528541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILEEN BERNAS MITROVIC PT

Provider Business Mailing Address
First Line	:	500 UNIVERSITY DR
Second Line	:	MC A410
City	:	HERSHEY
State	:	PA
Zip	:	17033-2360
Country	:	US
Telephone Number	:	180-024-3145
Fax Number	:	717-531-7269

Provider Business Practice Location Address
First Line	:	30 HOPE DR
Second Line	:	MC EC130
City	:	HERSHEY
State	:	PA
Zip	:	17033-2036
Country	:	US
Telephone Number	:	717-531-8070
Fax Number	:	717-531-0138

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	01/18/2011

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