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Organization
IXL REHAB & FITNESS CENTER LLC
Active
Organization
IXL REHAB & FITNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J SHARR PT, DPT, CLT-LANA (PRESIDENT)
(724) 662-1776
Entity
Organization
Contact information
Practice address
139 NORTH ERIE STREET, MERCER, PA 16137-1204
(724) 662-1776
(724) 662-1858
Mailing address
139 NORTH ERIE STREET, MERCER, PA 16137-1204
(724) 662-1776
(724) 662-1858
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT005706-L
PA
332B00000X
Durable Medical Equipment & Medical Supplies
4000007220
PA
332BC3200X
Customized Equipment (DME)
4000007220
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10114998000001
—
PA
Enumeration date
07/28/2005
Last updated
08/03/2016
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