MEDICARE: MRS. CHRISTINE DIANE MEASE MPT

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	QA007131	NJ
2	225100000X	Physical Therapist	PT009660L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22-21170196	OTHER	NJ	NJ CARPENTERS
2	2356297000	OTHER	NJ	AMERIHEALTH HMO
3	P3314980	OTHER	NJ	OXFORD
4	22-2170196	OTHER	NJ	INTERGROUP
5	22-2170196	OTHER	NJ	DEVON
6	1682858	OTHER	NJ	AMERIHEALTH PPO
7	1682858	OTHER	NJ	PA BLUE SHIELD
8	22-2170196	OTHER	NJ	SIMCARE
9	22-2170196	OTHER	NJ	HORIZON BSNJ
10	22-2170196	OTHER	NJ	FIRST HEALTH
11	222107019643	OTHER	NJ	TRICARE/CHAMPUS
12	222170196041	OTHER	NJ	TRICARE/CHAMPUS
13	22-2170196	OTHER	NJ	LOCAL 825

General Provider Information

NPI Number	:	1053319921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE DIANE MEASE MPT

Provider Business Mailing Address
First Line	:	209 CARLTON CT
Second Line	:
City	:	THOROFARE
State	:	NJ
Zip	:	08086-2017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 GROVE ST
Second Line	:	COOPER PHYSICAL THERAPY
City	:	HADDONFIELD
State	:	NJ
Zip	:	08033-1224
Country	:	US
Telephone Number	:	856-795-9330
Fax Number	:	856-854-7935

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	12/16/2013

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