MEDICARE: SHAWN MICHAEL STANISLAW 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	225100000X	Physical Therapist	PT022821	PA

General Provider Information

NPI Number	:	1649602525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN MICHAEL STANISLAW DPT

Provider Business Mailing Address
First Line	:	75 EVELYN DR
Second Line	:
City	:	MILLERSBURG
State	:	PA
Zip	:	17061-1258
Country	:	US
Telephone Number	:	717-692-4708
Fax Number	:	717-692-4715

Provider Business Practice Location Address
First Line	:	836 HOUSTON RUN DR
Second Line	:	SUITE 101
City	:	GAP
State	:	PA
Zip	:	17527-9496
Country	:	US
Telephone Number	:	717-442-8957
Fax Number	:

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

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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