MEDICARE: SUSQUEHANNA PHYSICAL THERAPY ASSOCIATES, INC.

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

General Provider Information

NPI Number	:	1255373585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSQUEHANNA PHYSICAL THERAPY ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	665 PHILADELPHIA ST
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-3941
Country	:	US
Telephone Number	:	724-465-3496
Fax Number	:	724-465-3726

Provider Business Practice Location Address
First Line	:	410 GLENN AVE
Second Line	:
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-1200
Country	:	US
Telephone Number	:	570-387-2135
Fax Number	:	570-387-2288

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. DENNIS FITZPATRICK
Credential	:
Telephone Number	:	610-644-7824

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	08/22/2020

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