MEDICARE: KEVIN BASILE 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	DAPT001140	PA
2	225100000X	Physical Therapist	40QA01673600	NJ

General Provider Information

NPI Number	:	1346351160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN BASILE P.T.

Provider Business Mailing Address
First Line	:	3635 QUAKERBRIDGE RD
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-1247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3635 QUAKERBRIDGE RD
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-1247
Country	:	US
Telephone Number	:	609-631-5200
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/31/2017

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Directions to “ KEVIN BASILE P.T.” Practice Location

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