MEDICARE: SPORTS AND ORTHOPEDIC REHABILITATION SERVICES, 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	261QR0400X	Rehabilitation Clinic/Center
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1730719816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPORTS AND ORTHOPEDIC REHABILITATION SERVICES, INC.

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

Provider Business Practice Location Address
First Line	:	8429 TUTTLE AVE # 234-236
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34243-2868
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:

Authorized Official
Title or Position	:	CHIEF LEGAL OFFICER
Name	:	JOHN F DUGGAN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	01/17/2020
Last Update Date	:	04/16/2026

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