MEDICARE: PHYSIOTHERAPY ASSOCIATES, 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1609465475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSIOTHERAPY ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 TAMAL VISTA BLVD STE 113
Second Line	:
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1114
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL TARVIN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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