MEDICARE: PENNSYLVANIA FRANCHISE AUTHORITY

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	335E00000X	Prosthetic/Orthotic Supplier	6000006672	PA

General Provider Information

NPI Number	:	1730356437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNSYLVANIA FRANCHISE AUTHORITY

Provider Business Mailing Address
First Line	:	5080D JONESTOWN RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-4906
Country	:	US
Telephone Number	:	717-731-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 HARTZDALE DR
Second Line	:	SUITE 128
City	:	CAMP HILL
State	:	PA
Zip	:	17011-7200
Country	:	US
Telephone Number	:	717-731-5600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. REX KING
Credential	:	C.PED.
Telephone Number	:	717-731-5600

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	05/12/2008

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Directions to “PENNSYLVANIA FRANCHISE AUTHORITY ” Practice Location

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