MEDICARE: MR. NOEL GASPAR 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	225100000X	Physical Therapist	40QA01162000	NJ

General Provider Information

NPI Number	:	1679789515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NOEL GASPAR P.T.

Provider Business Mailing Address
First Line	:	18 STOCKTON LN
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-6408
Country	:	US
Telephone Number	:	609-645-0485
Fax Number	:	609-645-0485

Provider Business Practice Location Address
First Line	:	18 STOCKTON LN
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-6408
Country	:	US
Telephone Number	:	609-645-0485
Fax Number	:	609-645-0485

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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