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NPI Code Detail

MEDICARE: SMR BANYAN TREE, INC.

MEDICARE: SMR BANYAN TREE, 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
1261QR0400XRehabilitation Clinic/Center
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1679519003
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMR BANYAN TREE, INC.
Provider Business Mailing Address
First Line : 4714 GETTYSBURG ROAD
Second Line : LEGAL DEPT
City : MECHANICSBURG
State : PA
Zip : 17055-4325
Country : US
Telephone Number : 717-972-1100
Fax Number :
Provider Business Practice Location Address
First Line : 5514 NIKE DR
Second Line :
City : HILLIARD
State : OH
Zip : 43026-9081
Country : US
Telephone Number : 614-529-8733
Fax Number : 614-529-6751
Authorized Official
Title or Position : VICE PRESIDENT & SECRETARY
Name : MR. MICHAEL E TARVIN
Credential :
Telephone Number : 717-972-1100
Provider Enumeration Date : 06/22/2006
Last Update Date : 11/21/2018

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Directions to “SMR BANYAN TREE, INC. ” Practice Location

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