MEDICARE: DOUGLAS ANDREW DANNEHOWER PT, OCS

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	40QA00338000	NJ
2	2251X0800X	Orthopedic Physical Therapist	40QA00338000	NJ

General Provider Information

NPI Number	:	1376502963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS ANDREW DANNEHOWER PT, OCS

Provider Business Mailing Address
First Line	:	210 S SHORE RD STE 203
Second Line	:
City	:	MARMORA
State	:	NJ
Zip	:	08223-1271
Country	:	US
Telephone Number	:	609-309-2400
Fax Number	:	609-390-9587

Provider Business Practice Location Address
First Line	:	210 S SHORE RD STE 203
Second Line	:
City	:	MARMORA
State	:	NJ
Zip	:	08223-1271
Country	:	US
Telephone Number	:	609-309-2400
Fax Number	:	609-390-9587

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	08/01/2020

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