MEDICARE: ELLEN JANE VANBUSKIRK 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	TEI002486	PA

General Provider Information

NPI Number	:	1942567813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN JANE VANBUSKIRK PTA

Provider Business Mailing Address
First Line	:	829 ELECTRIC ST
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18509-1903
Country	:	US
Telephone Number	:	570-878-8363
Fax Number	:

Provider Business Practice Location Address
First Line	:	829 ELECTRIC ST
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18509-1903
Country	:	US
Telephone Number	:	570-878-8363
Fax Number	:

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

Provider Enumeration Date	:	04/17/2012
Last Update Date	:	04/17/2012

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