Provider Demographics
NPI:1164773768
Name:GEORGE, ALAN
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 GROFF AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 GROFF AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2824
Practice Address - Country:US
Practice Address - Phone:717-201-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26976222Q00000X
PAPT020051222Q00000X
IL070.019226222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070.019226OtherILLINOIS STATE BOARD OF PHYSICAL THERAPY
FLPT26976OtherFLORIDA BOARD OF PHYSICAL THERAPY
PAPT020051OtherPENNSYLVANIA STATE BOARD OF PHYSICAL THERAPY