MEDICARE: JOHN WALTER KLINKNER BS

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	PT007127L	PA

General Provider Information

NPI Number	:	1356598445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WALTER KLINKNER BS

Provider Business Mailing Address
First Line	:	112 AMBER CT
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-7102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 W VIEW PARK DR
Second Line	:	SUITE 7/8
City	:	PITTSBURGH
State	:	PA
Zip	:	15229-1785
Country	:	US
Telephone Number	:	412-931-2850
Fax Number	:

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

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	08/20/2008

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