MEDICARE: CROWLEY PHYSICAL THERAPY CLINIC 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		LA

General Provider Information

NPI Number	:	1609871524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROWLEY PHYSICAL THERAPY CLINIC INC

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:	LEGAL DEPARTMENT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	1455 WRIGHT AVE
Second Line	:
City	:	CROWLEY
State	:	LA
Zip	:	70526-2220
Country	:	US
Telephone Number	:	337-788-1480
Fax Number	:	337-788-0354

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	02/07/2011

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