MEDICARE: SPORTS AND ORTHOPEDIC REHABILITATION SERVICES INC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1972646396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPORTS AND ORTHOPEDIC REHABILITATION SERVICES INC

Provider Business Mailing Address
First Line	:	4716 GETTYSBURG RD
Second Line	:	LEGAL DEPARTMENT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-975-4503
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	1701 PARK CENTER DR
Second Line	:	SUITE 203
City	:	ORLANDO
State	:	FL
Zip	:	32835-6235
Country	:	US
Telephone Number	:	407-294-5500
Fax Number	:	407-294-5400

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL E. TARVIN
Credential	:
Telephone Number	:	717-975-4503

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	08/08/2017

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