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NPI Code Detail

MEDICARE: SUSAN WHARTON PTA

MEDICARE: SUSAN WHARTON PTA
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
1225200000XPhysical Therapy Assistant40QB00240200NJ

General Provider Information

NPI Number : 1043432362
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN WHARTON PTA
Provider Business Mailing Address
First Line : 313 PETITT AVE
Second Line :
City : CHERRY HILL
State : NJ
Zip : 08002-2303
Country : US
Telephone Number : 856-486-9275
Fax Number :
Provider Business Practice Location Address
First Line : 2150 ROUTE 38
Second Line :
City : CHERRY HILL
State : NJ
Zip : 08002-4302
Country : US
Telephone Number : 856-667-4550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2007
Last Update Date : 07/08/2007

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