MEDICARE: PT MAX PAIN MANAGEMENT CLINIC

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	020505	PA

General Provider Information

NPI Number	:	1093094468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PT MAX PAIN MANAGEMENT CLINIC

Provider Business Mailing Address
First Line	:	2040 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-3817
Country	:	US
Telephone Number	:	215-278-2229
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-3817
Country	:	US
Telephone Number	:	215-278-2229
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	ERUM KHAN
Credential	:	PT
Telephone Number	:	407-761-2404

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	07/28/2016

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