MEDICARE: MRS. WENDY M. PICKARD PTA

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	225200000X	Physical Therapy Assistant	40QB00161300	NJ

General Provider Information

NPI Number	:	1124417670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY M. PICKARD PTA

Provider Business Mailing Address
First Line	:	212 MARTER AVE
Second Line	:
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-3114
Country	:	US
Telephone Number	:	856-291-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 MARTER AVE
Second Line	:
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-3114
Country	:	US
Telephone Number	:	856-291-4800
Fax Number	:

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

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	01/21/2015

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