MEDICARE: DR. MATTHEW MCGILLEN PT, DPT

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	40QA01799800	NJ
2	225100000X	Physical Therapist	PT028893	PA

General Provider Information

NPI Number	:	1114499381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW MCGILLEN PT, DPT

Provider Business Mailing Address
First Line	:	2000 RUBY CREST DR APT 2302
Second Line	:
City	:	MALVERN
State	:	PA
Zip	:	19355-8825
Country	:	US
Telephone Number	:	609-923-2421
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 E MAIN ST
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-2936
Country	:	US
Telephone Number	:	609-923-2421
Fax Number	:

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

Provider Enumeration Date	:	12/27/2018
Last Update Date	:	03/30/2021

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