MEDICARE: NORTHWESTERN PHYSICAL THERAPY AND FITNESS, INC.

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

General Provider Information

NPI Number	:	1437180460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWESTERN PHYSICAL THERAPY AND FITNESS, INC.

Provider Business Mailing Address
First Line	:	6305 ROUTE 309
Second Line	:
City	:	NEW TRIPOLI
State	:	PA
Zip	:	18066-2000
Country	:	US
Telephone Number	:	610-767-8480
Fax Number	:	610-767-8487

Provider Business Practice Location Address
First Line	:	6299 ROUTE 309
Second Line	:	SUITE 305
City	:	NEW TRIPOLI
State	:	PA
Zip	:	18066-2000
Country	:	US
Telephone Number	:	610-767-8480
Fax Number	:	610-767-8487

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARCUS KYLE SMURDA
Credential	:	DPT
Telephone Number	:	610-767-8480

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	05/08/2012

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