MEDICARE: BRIAN MATTHEW CLOUSE 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
1	225200000X	Physical Therapy Assistant	TEI004818	PA

General Provider Information

NPI Number	:	1427717032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN MATTHEW CLOUSE PTA

Provider Business Mailing Address
First Line	:	2781 LUTHER DR
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17202-8131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2781 LUTHER DR
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17202-8131
Country	:	US
Telephone Number	:	717-660-2482
Fax Number	:

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

Provider Enumeration Date	:	12/10/2021
Last Update Date	:	12/10/2021

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