MEDICARE: LD RECOVERY SOLUTIONS, INC.

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician

General Provider Information

NPI Number	:	1033696703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LD RECOVERY SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	521 FELLOWSHIP RD STE 155
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-3442
Country	:	US
Telephone Number	:	856-439-6772
Fax Number	:	856-206-0519

Provider Business Practice Location Address
First Line	:	521 FELLOWSHIP RD STE 155
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-3442
Country	:	US
Telephone Number	:	856-439-6772
Fax Number	:	856-206-0519

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LESLIE CHRISTINE CLARK
Credential	:
Telephone Number	:	856-439-6772

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	07/25/2018

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