MEDICARE: BRIAN PATRICK WOMELSDORF ATC

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	174400000X	Specialist	RT003054	PA

General Provider Information

NPI Number	:	1730257247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN PATRICK WOMELSDORF ATC

Provider Business Mailing Address
First Line	:	8 WILLIAM HOWARD DR
Second Line	:
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-1366
Country	:	US
Telephone Number	:	484-716-2497
Fax Number	:

Provider Business Practice Location Address
First Line	:	7604 CENTRAL AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19111-2433
Country	:	US
Telephone Number	:	215-214-6655
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/08/2007

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