MEDICARE: MAUREEN WOLVERTON 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	40QA00965700	NJ

General Provider Information

NPI Number	:	1548404916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN WOLVERTON PT

Provider Business Mailing Address
First Line	:	7 SANTA CLARA TRL
Second Line	:
City	:	BROWNS MILLS
State	:	NJ
Zip	:	08015-6621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 RANCOCAS RD
Second Line	:
City	:	BURLINGTON TOWNSHIP
State	:	NJ
Zip	:	08016
Country	:	US
Telephone Number	:	609-387-9300
Fax Number	:

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

Provider Enumeration Date	:	04/28/2009
Last Update Date	:	09/01/2009

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