MEDICARE: JOEL BERQUAM PT

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	2251X0800X	Orthopedic Physical Therapist	5094	AL

General Provider Information

NPI Number	:	1841221074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL BERQUAM PT

Provider Business Mailing Address
First Line	:	477 YANCEY ST
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36832-8764
Country	:	US
Telephone Number	:	919-619-4015
Fax Number	:

Provider Business Practice Location Address
First Line	:	477 YANCEY ST
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36832-8764
Country	:	US
Telephone Number	:	919-619-4015
Fax Number	:

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	10/12/2015

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Directions to “ JOEL BERQUAM PT” Practice Location

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