MEDICARE: DEBRA BAXTER MANN P.T.

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	172M00000X	Mechanotherapist	40QA00348500	NJ

General Provider Information

NPI Number	:	1568772887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA BAXTER MANN P.T.

Provider Business Mailing Address
First Line	:	84 COLD HILL ROAD
Second Line	:
City	:	MENDHAM
State	:	NJ
Zip	:	07945-0001
Country	:	US
Telephone Number	:	973-543-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 COLD HILL RD.
Second Line	:
City	:	MENDHAM
State	:	NJ
Zip	:	07945-0000
Country	:	US
Telephone Number	:	973-543-2500
Fax Number	:

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

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	10/20/2010

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