MEDICARE: MRS. KRISTEN M MARKLE LPTA

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	2251X0800X	Orthopedic Physical Therapist	TEI004159	PA
2	225200000X	Physical Therapy Assistant	TEI004159	PA

General Provider Information

NPI Number	:	1265052815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN M MARKLE LPTA

Provider Business Mailing Address
First Line	:	796 MILL RD
Second Line	:
City	:	SPRING GROVE
State	:	PA
Zip	:	17362-9183
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	796 MILL RD
Second Line	:
City	:	SPRING GROVE
State	:	PA
Zip	:	17362-9183
Country	:	US
Telephone Number	:	717-965-2026
Fax Number	:

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

Provider Enumeration Date	:	04/23/2020
Last Update Date	:	04/23/2020

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