Healthcare Provider Details

I. General information

NPI: 1184624868
Provider Name (Legal Business Name): MARSHA ELLEN BERGER GRANT MS PT OCJ
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HORIZON DR STE 102E
CHALFONT PA
18914-3966
US

IV. Provider business mailing address

676 DE KALB PIKE STE 205
BLUE BELL PA
19422-1223
US

V. Phone/Fax

Practice location:
  • Phone: 215-712-0300
  • Fax: 215-712-9040
Mailing address:
  • Phone: 610-270-0380
  • Fax: 610-270-0874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT005482L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: