MEDICARE: NOVACARE OUTPATIENT REHABILITATION EAST 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	261QP2000X	Physical Therapy Clinic/Center		MI

General Provider Information

NPI Number	:	1821094202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVACARE OUTPATIENT REHABILITATION EAST INC

Provider Business Mailing Address
First Line	:	4716 OLD GETTYSBURG RD.
Second Line	:	LEGAL DEAPARTMENT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-975-4503
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	1255 N OAKLAND BLVD
Second Line	:	STE 145
City	:	WATERFORD
State	:	MI
Zip	:	48327-1578
Country	:	US
Telephone Number	:	248-666-3329
Fax Number	:	248-666-5372

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MICHAEL E. TARVIN
Credential	:
Telephone Number	:	717-975-4503

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/12/2008

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