MEDICARE: MATTHEW PENNEY PT

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	10697	MA

General Provider Information

NPI Number	:	1043291198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW PENNEY PT

Provider Business Mailing Address
First Line	:	260 TREMONT ST
Second Line	:	PO BOX 120008
City	:	BOSTON
State	:	MA
Zip	:	02112-5603
Country	:	US
Telephone Number	:	617-636-5175
Fax Number	:	617-636-5176

Provider Business Practice Location Address
First Line	:	260 TREMONT ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02116-5603
Country	:	US
Telephone Number	:	617-636-5175
Fax Number	:	617-636-5176

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	07/08/2007

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Directions to “ MATTHEW PENNEY PT” Practice Location

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