MEDICARE: MRS. KIMBERLY ERSIN P.T.

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	PT013754L	PA

General Provider Information

NPI Number	:	1063488989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ERSIN P.T.

Provider Business Mailing Address
First Line	:	1514 KNOX RD
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-2516
Country	:	US
Telephone Number	:	610-649-1694
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 S CHESTER RD
Second Line	:
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-2315
Country	:	US
Telephone Number	:	610-543-1201
Fax Number	:	610-328-5205

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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