MEDICARE: BRYAN LEO BATKIEWICZ 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	PT016807	PA

General Provider Information

NPI Number	:	1447469234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN LEO BATKIEWICZ PT

Provider Business Mailing Address
First Line	:	991 ROUTE 19 N STE E
Second Line	:
City	:	WATERFORD
State	:	PA
Zip	:	16441-9739
Country	:	US
Telephone Number	:	814-796-3400
Fax Number	:	814-796-8533

Provider Business Practice Location Address
First Line	:	991 ROUTE 19 N STE E
Second Line	:
City	:	WATERFORD
State	:	PA
Zip	:	16441-9739
Country	:	US
Telephone Number	:	814-796-3400
Fax Number	:	814-796-8533

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	04/25/2011

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