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NPI Code Detail

MEDICARE: MRS. JAMIE MCCULLOH-MARTIN PT

MEDICARE: MRS. JAMIE MCCULLOH-MARTIN 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
1225100000XPhysical Therapist40QA00495400NJ

General Provider Information

NPI Number : 1225363955
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JAMIE MCCULLOH-MARTIN PT
Provider Business Mailing Address
First Line : 224 STRAWBRIDGE DR STE 100
Second Line :
City : MOORESTOWN
State : NJ
Zip : 08057-4602
Country : US
Telephone Number : 856-677-4000
Fax Number : 856-234-3014
Provider Business Practice Location Address
First Line : 740 MARNE HWY STE 203
Second Line :
City : MOORESTOWN
State : NJ
Zip : 08057-3127
Country : US
Telephone Number : 856-914-1400
Fax Number : 856-914-1444
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2009
Last Update Date : 04/01/2020

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