MEDICARE: MRS. SEEMA AMBADY 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	171W00000X	Contractor	40QA01056900	NJ
2	2251X0800X	Orthopedic Physical Therapist	40QA01056900	NJ
3	225100000X	Physical Therapist	PT0300518	PA

General Provider Information

NPI Number	:	1376796557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SEEMA AMBADY PT

Provider Business Mailing Address
First Line	:	117 STONE FENCE RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-6115
Country	:	US
Telephone Number	:	201-403-5904
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 STONE FENCE RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-6115
Country	:	US
Telephone Number	:	201-403-5904
Fax Number	:

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

Provider Enumeration Date	:	10/31/2008
Last Update Date	:	08/19/2022

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