MEDICARE: JONATHAN LIN PT, DPT, ATC, CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01530200	NJ
2	2255A2300X	Athletic Trainer	002321-1	NY
3	2255A2300X	Athletic Trainer	25MT00184700	NJ

General Provider Information

NPI Number	:	1023350444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN LIN PT, DPT, ATC, CSCS

Provider Business Mailing Address
First Line	:	32-3 LILAC DR.
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620
Country	:	US
Telephone Number	:	206-697-2545
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 GIANTS DR
Second Line	:
City	:	EAST RUTHERFORD
State	:	NJ
Zip	:	07073-2140
Country	:	US
Telephone Number	:	206-697-2545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2013
Last Update Date	:	04/16/2014

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