MEDICARE: LISA CRESCENTI DPT

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	PT021264	PA

General Provider Information

NPI Number	:	1447705892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA CRESCENTI DPT

Provider Business Mailing Address
First Line	:	7 CARNEGIE PLZ
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-1000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2513 S HICKS ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4603
Country	:	US
Telephone Number	:	609-502-2430
Fax Number	:

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

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	08/15/2016

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