MEDICARE: BRETT MCCOMBS PTA

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	225200000X	Physical Therapy Assistant	TE011714	PA

General Provider Information

NPI Number	:	1538624408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT MCCOMBS PTA

Provider Business Mailing Address
First Line	:	4105 CHANDLER DR
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-1602
Country	:	US
Telephone Number	:	610-937-9350
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 EDGMONT AVE
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-2807
Country	:	US
Telephone Number	:	610-876-6180
Fax Number	:

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

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	02/05/2019

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Directions to “ BRETT MCCOMBS PTA” Practice Location

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