MEDICARE: ANDREW J EMERY P.T.

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	225100000X	Physical Therapist	040-0003605	VT
2	225100000X	Physical Therapist	PT1904	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT1904	OTHER	NV	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1043228521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW J EMERY P.T.

Provider Business Mailing Address
First Line	:	PO BOX 106
Second Line	:
City	:	NEWPORT CENTER
State	:	VT
Zip	:	05857
Country	:	US
Telephone Number	:	802-334-8882
Fax Number	:	802-334-8868

Provider Business Practice Location Address
First Line	:	2542 VT RTE 105
Second Line	:
City	:	NEWPORT CENTER
State	:	VT
Zip	:	05857
Country	:	US
Telephone Number	:	802-334-8882
Fax Number	:	802-334-8868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	10/24/2008

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