MEDICARE: NEUROLOGY PSYCHIATRY AND BALANCE THERAPY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	2084P0800X	Psychiatry Physician	PA
2	225100000X	Physical Therapist	PA
3	2084N0400X	Neurology Physician	PA

General Provider Information

NPI Number	:	1932466729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGY PSYCHIATRY AND BALANCE THERAPY CENTER LLC

Provider Business Mailing Address
First Line	:	725 SKIPPACK PIKE
Second Line	:	PAREC PLAZA, SUITE 130
City	:	BLUE BELL
State	:	PA
Zip	:	19422-1704
Country	:	US
Telephone Number	:	215-591-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 SKIPPACK PIKE
Second Line	:	PAREC PLAZA, SUITE 130
City	:	BLUE BELL
State	:	PA
Zip	:	19422-1704
Country	:	US
Telephone Number	:	215-591-0700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SONYA KNIGHT
Credential	:	DO
Telephone Number	:	215-591-0700

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	04/24/2012

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