MEDICARE: MITCHELL LEATHERMAN ASPT

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	208100000X	Physical Medicine & Rehabilitation Physician	TEI004386	PA

General Provider Information

NPI Number	:	1497354963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL LEATHERMAN ASPT

Provider Business Mailing Address
First Line	:	113 S MAIN ST
Second Line	:
City	:	RICHLANDTOWN
State	:	PA
Zip	:	18955-1050
Country	:	US
Telephone Number	:	267-733-7878
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 MAPLE AVE
Second Line	:
City	:	HARLEYSVILLE
State	:	PA
Zip	:	19438-1032
Country	:	US
Telephone Number	:	215-256-9501
Fax Number	:

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

Provider Enumeration Date	:	10/25/2020
Last Update Date	:	10/25/2020

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