Organization
DEVELOPMENTAL & DISABILITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT G HAYNES (FISCAL MANAGER)
(717) 274-3493
Entity
Organization
Contact information
Practice address
1126 WALNUT ST, LEBANON, PA 17042-5950
(717) 274-3493
(717) 274-1304
Mailing address
1126 WALNUT ST, LEBANON, PA 17042-5950
(717) 274-3493
(717) 274-1304
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000036870006
—
PA
Enumeration date
03/14/2007
Last updated
09/11/2025
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