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NPI Code Detail

MEDICARE: MITCHELL GUIMARAES LACERDA

MEDICARE: MITCHELL GUIMARAES LACERDA
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
1225200000XPhysical Therapy AssistantTE012969PA

General Provider Information

NPI Number : 1922767003
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITCHELL GUIMARAES LACERDA
Provider Business Mailing Address
First Line : 1705 TOWNHOUSE BLVD
Second Line :
City : SCRANTON
State : PA
Zip : 18508-2414
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2004 OLD ARCH RD
Second Line :
City : NORRISTOWN
State : PA
Zip : 19401-2008
Country : US
Telephone Number : 610-277-0380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2021
Last Update Date : 12/15/2021

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Directions to “ MITCHELL GUIMARAES LACERDA ” Practice Location

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