MEDICARE: MR. ALEXANDER CRISTOBAL P.T.

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	PT008897E	PA

General Provider Information

NPI Number	:	1952435380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEXANDER CRISTOBAL P.T.

Provider Business Mailing Address
First Line	:	15 SUNNYSIDE DR
Second Line	:
City	:	LEWISBURG
State	:	PA
Zip	:	17837-7084
Country	:	US
Telephone Number	:	570-606-4760
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 MARKET ST
Second Line	:
City	:	SUNBURY
State	:	PA
Zip	:	17801-2403
Country	:	US
Telephone Number	:	570-286-6922
Fax Number	:	570-286-8175

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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