Provider Demographics
NPI:1396702981
Name:BRONSON, SHANE J (PT)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:J
Last Name:BRONSON
Suffix:
Gender:M
Credentials:PT
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Other - First Name:
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Mailing Address - Street 1:4750 LINDLE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2428
Mailing Address - Country:US
Mailing Address - Phone:717-803-3342
Mailing Address - Fax:717-974-8743
Practice Address - Street 1:2836 EARLYSTOWN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CENTRE HALL
Practice Address - State:PA
Practice Address - Zip Code:16828-9162
Practice Address - Country:US
Practice Address - Phone:814-974-2934
Practice Address - Fax:814-414-4056
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAPT016294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA121439Medicare Oscar/Certification