MEDICARE: ELMTREE WELLNESS CENTER, INC.

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	261QP2000X	Physical Therapy Clinic/Center	018579	PA

General Provider Information

NPI Number	:	1497293518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELMTREE WELLNESS CENTER, INC.

Provider Business Mailing Address
First Line	:	2489 ROUTE 6
Second Line	:	SUITE 6
City	:	HAWLEY
State	:	PA
Zip	:	18428-6078
Country	:	US
Telephone Number	:	570-390-7900
Fax Number	:	570-390-7901

Provider Business Practice Location Address
First Line	:	2489 ROUTE 6
Second Line	:	SUITE 6
City	:	HAWLEY
State	:	PA
Zip	:	18428-6078
Country	:	US
Telephone Number	:	570-390-7900
Fax Number	:	570-390-7901

Authorized Official
Title or Position	:	PT/OWNER
Name	:	SUSAN PASQUINI
Credential	:	MSPT
Telephone Number	:	570-390-7900

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	04/15/2021

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