MEDICARE: MARIA ROSA DOZ VERA 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	225100000X	Physical Therapist	40QA00774400	NJ

General Provider Information

NPI Number	:	1467759829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ROSA DOZ VERA PT

Provider Business Mailing Address
First Line	:	27 SAINT PAULS AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-1662
Country	:	US
Telephone Number	:	201-792-0504
Fax Number	:	201-855-4516

Provider Business Practice Location Address
First Line	:	27 SAINT PAULS AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-1662
Country	:	US
Telephone Number	:	201-792-0504
Fax Number	:	201-855-4516

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

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	02/22/2011

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