Healthcare Provider Details

I. General information

NPI: 1548404916
Provider Name (Legal Business Name): MAUREEN WOLVERTON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 RANCOCAS RD
BURLINGTON TOWNSHIP NJ
08016
US

IV. Provider business mailing address

7 SANTA CLARA TRL
BROWNS MILLS NJ
08015-6621
US

V. Phone/Fax

Practice location:
  • Phone: 609-387-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00965700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: