MEDICARE: CHARLENE TISSENBAUM 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	PT008338L	PA

General Provider Information

NPI Number	:	1356674089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE TISSENBAUM PT

Provider Business Mailing Address
First Line	:	625 LINCOLN AVE STE 107
Second Line	:
City	:	CHARLEROI
State	:	PA
Zip	:	15022-2451
Country	:	US
Telephone Number	:	724-483-1673
Fax Number	:	724-483-0290

Provider Business Practice Location Address
First Line	:	1146 W CHESTNUT ST
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-4631
Country	:	US
Telephone Number	:	724-223-1207
Fax Number	:	724-223-1209

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

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/14/2009

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