1376564609 NPI number — SHELLEY D BITNER P.T.

Table of content: SHELLEY D BITNER P.T. (NPI 1376564609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376564609 NPI number — SHELLEY D BITNER P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BITNER
Provider First Name:
SHELLEY
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376564609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 FLOWERS DR
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17050-1714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-245-2341
Provider Business Mailing Address Fax Number:
717-245-9672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 TYLER CT
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17015-7913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-245-2341
Provider Business Practice Location Address Fax Number:
717-245-9672
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT005267L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 506259 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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