MEDICARE: PR ACQUISITION CORPORATION

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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1992766687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PR ACQUISITION CORPORATION

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:	LEGAL DEPARTMENT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 W CRAIG RD STE 210
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0224
Country	:	US
Telephone Number	:	702-360-9142
Fax Number	:	702-360-9147

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL TARVIN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	11/05/2018

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Directions to “PR ACQUISITION CORPORATION ” Practice Location

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