MEDICARE: JACQUELINE SCHUYLER 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	40QA00378900	NJ

General Provider Information

NPI Number	:	1053325944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE SCHUYLER MPT

Provider Business Mailing Address
First Line	:	154 TREE TOP DR
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 MAIN ST
Second Line	:
City	:	MADISON
State	:	NJ
Zip	:	07940-2285
Country	:	US
Telephone Number	:	973-377-6700
Fax Number	:	973-377-8008

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	02/05/2010

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