MEDICARE: MS. SUSAN I MCCREA P.T.

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	PT006539L	PA

General Provider Information

NPI Number	:	1740434836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN I MCCREA P.T.

Provider Business Mailing Address
First Line	:	200 RENAISSANCE DR
Second Line	:	SUITE 301
City	:	BUTLER
State	:	PA
Zip	:	16001-7612
Country	:	US
Telephone Number	:	724-282-0755
Fax Number	:	724-282-7723

Provider Business Practice Location Address
First Line	:	200 RENAISSANCE DR
Second Line	:	SUITE 301
City	:	BUTLER
State	:	PA
Zip	:	16001-7612
Country	:	US
Telephone Number	:	724-282-0755
Fax Number	:	724-282-7723

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

Provider Enumeration Date	:	11/17/2008
Last Update Date	:	11/17/2008

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