MEDICARE: TEAM REHAB P.A

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	40QA00400900	NJ

General Provider Information

NPI Number	:	1699794784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAM REHAB P.A

Provider Business Mailing Address
First Line	:	1007 MANTUA PIKE
Second Line	:
City	:	WOODBURY
State	:	NJ
Zip	:	08096-3963
Country	:	US
Telephone Number	:	856-845-1253
Fax Number	:	856-845-3779

Provider Business Practice Location Address
First Line	:	1007 MANTUA PIKE
Second Line	:
City	:	WOODBURY
State	:	NJ
Zip	:	08096-3963
Country	:	US
Telephone Number	:	856-845-1253
Fax Number	:	856-845-3779

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL JOHN DONOGHUE
Credential	:	PT
Telephone Number	:	856-845-1253

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	05/21/2009

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Directions to “TEAM REHAB P.A ” Practice Location

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