Provider Demographics
NPI:1306805247
Name:MCCUEN & ASSOCIATES PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:MCCUEN & ASSOCIATES PHYSICAL THERAPY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARKUFF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:717-737-9818
Mailing Address - Street 1:550 N 12TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1213
Mailing Address - Country:US
Mailing Address - Phone:717-737-9818
Mailing Address - Fax:717-737-2815
Practice Address - Street 1:550 N 12TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1213
Practice Address - Country:US
Practice Address - Phone:717-737-9818
Practice Address - Fax:717-737-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003548L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA022273Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER