Healthcare Provider Details

I. General information

NPI: 1174553267
Provider Name (Legal Business Name): MICHAEL JOHN HUGHES PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8131 ROOSEVELT BLVD
PHILADELPHIA PA
19152-3013
US

IV. Provider business mailing address

934 HARTEL AVE
PHILADELPHIA PA
19111-3202
US

V. Phone/Fax

Practice location:
  • Phone: 215-335-3954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberPT003040L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: