MEDICARE: MR. STEPHEN BRIGLIA STEPHEN BRIGLIA

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	40QB00292000	NJ

General Provider Information

NPI Number	:	1639420763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN BRIGLIA STEPHEN BRIGLIA

Provider Business Mailing Address
First Line	:	1508 PROSPECT RIDGE BLVD
Second Line	:
City	:	HADDON HEIGHTS
State	:	NJ
Zip	:	08035-1528
Country	:	US
Telephone Number	:	609-238-9418
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 PROSPECT RIDGE BLVD
Second Line	:
City	:	HADDON HEIGHTS
State	:	NJ
Zip	:	08035-1528
Country	:	US
Telephone Number	:	609-238-9418
Fax Number	:

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

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	10/01/2012

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