MEDICARE: MR. JOHN MARTIN MCKILLOP PT

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	018137-1	NY

General Provider Information

NPI Number	:	1154448777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MARTIN MCKILLOP PT

Provider Business Mailing Address
First Line	:	631 SAW MILL RIVER RD
Second Line	:	SUITE 1N
City	:	ARDSLEY
State	:	NY
Zip	:	10502-2146
Country	:	US
Telephone Number	:	914-693-6377
Fax Number	:

Provider Business Practice Location Address
First Line	:	631 SAW MILL RIVER RD
Second Line	:	SUITE 1N
City	:	ARDSLEY
State	:	NY
Zip	:	10502-2146
Country	:	US
Telephone Number	:	914-693-6377
Fax Number	:	914-693-6384

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	03/06/2013

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