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NPI Code Detail

MEDICARE: JEREMY EVAN DAMIANO PTA

MEDICARE: JEREMY EVAN DAMIANO PTA
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
1225200000XPhysical Therapy AssistantTEI005193PA

General Provider Information

NPI Number : 1275003287
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY EVAN DAMIANO PTA
Provider Business Mailing Address
First Line : 515 BARRY CT
Second Line :
City : MECHANICSBURG
State : PA
Zip : 17050-4602
Country : US
Telephone Number : 717-417-0271
Fax Number :
Provider Business Practice Location Address
First Line : 1000 CLAREMONT RD
Second Line :
City : CARLISLE
State : PA
Zip : 17013-7310
Country : US
Telephone Number : 717-243-2031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2018
Last Update Date : 12/03/2018

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