MEDICARE: SUSQUEHANNA PHYSICIAN SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	261QP2000X	Physical Therapy Clinic/Center
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1982205472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSQUEHANNA PHYSICIAN SERVICES

Provider Business Mailing Address
First Line	:	1201 GRAMPIAN BLVD
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-1900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 S MAIN ST STE 1
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-1510
Country	:	US
Telephone Number	:	570-662-1920
Fax Number	:	570-662-1921

Authorized Official
Title or Position	:	VP/COO
Name	:	MELISSA DAVIS
Credential	:
Telephone Number	:	570-326-8544

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	12/17/2025

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