MEDICARE: DR. MARY LIMBACH FRIES P.T.

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	40QA01003100	NJ
2	225100000X	Physical Therapist	PT12559	CA

General Provider Information

NPI Number	:	1114278165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY LIMBACH FRIES P.T.

Provider Business Mailing Address
First Line	:	10 MEETINGHOUSE CT
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-7731
Country	:	US
Telephone Number	:	609-252-1865
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 WALTER ST
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08628-3016
Country	:	US
Telephone Number	:	609-883-5391
Fax Number	:

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

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	09/28/2012

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