MEDICARE: RYAN SHOWALTER DPT

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	PT029864	PA
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1528721529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN SHOWALTER DPT

Provider Business Mailing Address
First Line	:	5425 JONESTOWN RD STE 100
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-4086
Country	:	US
Telephone Number	:	717-901-6246
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 W CHOCOLATE AVE STE 3
Second Line	:
City	:	HERSHEY
State	:	PA
Zip	:	17033-1568
Country	:	US
Telephone Number	:	717-547-9100
Fax Number	:

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

Provider Enumeration Date	:	10/16/2021
Last Update Date	:	10/18/2021

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Directions to “ RYAN SHOWALTER DPT” Practice Location

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