MEDICARE: COMMONHEALTH ORTHOPEDIC PHYSICAL THERAPY

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	PT018772	PA

General Provider Information

NPI Number	:	1720365489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONHEALTH ORTHOPEDIC PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	7700 SUNSET DR
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-3857
Country	:	US
Telephone Number	:	717-585-0510
Fax Number	:

Provider Business Practice Location Address
First Line	:	337 W KING ST
Second Line	:
City	:	EAST BERLIN
State	:	PA
Zip	:	17316-9730
Country	:	US
Telephone Number	:	717-585-0510
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY
Name	:	DR. NATHANIEL G CREZNIC
Credential	:	D.P.T
Telephone Number	:	717-585-0510

Provider Enumeration Date	:	11/09/2011
Last Update Date	:	11/09/2011

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