MEDICARE: MR. DAREN M HARSH PTA

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	225200000X	Physical Therapy Assistant	PTA-03860	OH

General Provider Information

NPI Number	:	1902020530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAREN M HARSH PTA

Provider Business Mailing Address
First Line	:	1421 S NICKELPLATE
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641
Country	:	US
Telephone Number	:	330-875-1300
Fax Number	:	330-875-1311

Provider Business Practice Location Address
First Line	:	1421 S NICKELPLATE
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641
Country	:	US
Telephone Number	:	330-875-1300
Fax Number	:	330-875-1311

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	05/30/2008

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