Provider Demographics
NPI:1174528541
Name:MITROVIC, AILEEN BERNAS (PT)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:BERNAS
Last Name:MITROVIC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:
Other - Last Name:BERNAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:500 UNIVERSITY DR
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:180-024-3145
Mailing Address - Fax:717-531-7269
Practice Address - Street 1:30 HOPE DR
Practice Address - Street 2:MC EC130
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2036
Practice Address - Country:US
Practice Address - Phone:717-531-8070
Practice Address - Fax:717-531-0138
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009143E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10115472Medicaid
PA10115472Medicaid