MEDICARE: MRS. TRACY ANN STYBORSKI MPT

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	012822L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0026990101	OTHER	PA	UNIVERA
2	2322242	OTHER	PA	HEALTHAMERICA
3	001404683	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1376541052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY ANN STYBORSKI MPT

Provider Business Mailing Address
First Line	:	407 N CENTER ST
Second Line	:
City	:	CORRY
State	:	PA
Zip	:	16407-1203
Country	:	US
Telephone Number	:	814-663-7878
Fax Number	:	814-663-0661

Provider Business Practice Location Address
First Line	:	41 N CENTER ST
Second Line	:
City	:	CORRY
State	:	PA
Zip	:	16407-1622
Country	:	US
Telephone Number	:	814-663-7878
Fax Number	:	814-663-0661

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/13/2017

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