MEDICARE: MRS. VICTORIA MCBRYAN PT

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	PT005780L	PA

General Provider Information

NPI Number	:	1871899146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA MCBRYAN PT

Provider Business Mailing Address
First Line	:	201 ERIE ST STE B
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1659
Country	:	US
Telephone Number	:	724-458-5850
Fax Number	:	724-458-4402

Provider Business Practice Location Address
First Line	:	201 ERIE ST STE B
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1659
Country	:	US
Telephone Number	:	724-458-5850
Fax Number	:	724-458-4402

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

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	02/04/2011

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