MEDICARE: JOYNER SPORTS MEDICINE INSTITUTE 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		FL

General Provider Information

NPI Number	:	1568531077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOYNER SPORTS MEDICINE INSTITUTE INC

Provider Business Mailing Address
First Line	:	4716 GETTYSBURG RD
Second Line	:	LEGAL DEPARTMENT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-975-4503
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	900 VIRGINIA AVE
Second Line	:	SUITE 1-3
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5882
Country	:	US
Telephone Number	:	772-464-2581
Fax Number	:	772-464-7842

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL E. TARVIN
Credential	:
Telephone Number	:	717-975-4503

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	02/28/2008

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