MEDICARE: ELIZABETH MARY BUONANNO

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	PT033959	PA

General Provider Information

NPI Number	:	1568317436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARY BUONANNO

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	570-550-0168
Fax Number	:	410-648-4878

Provider Business Practice Location Address
First Line	:	6455 CARLISLE PIKE STE 2
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17050-2390
Country	:	US
Telephone Number	:	717-802-8767
Fax Number	:	717-708-9453

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

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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